University of Oregon

Applicant Data Request Forms

The University of Oregon is a government contractor subject to certain reporting requirements under Executive Order 11246, the Vietnam Era Veterans' Readjustment Assistance Act (VEVRAA), and Section 503 of the Rehabilitation Act of 1973. We also adhere to the Oregon Veterans' Preference in Employment regulations (ORS 408.225-408.237). Each of these laws or regulations requires us to request that applicants supply demographic information as well as information on veteran or disability status.

We are requesting that you supply the identifying information below and then complete the following self-identification forms.

* Required Don't know the posting number? Click here for available positions.

Voluntary Applicant Demographic Self-Identification Form

In accordance with Executive Order 11246, the University of Oregon requests demographic information related to ethnic group, race, and gender. This information will be kept confidential and is used only for statistical reporting purposes to meet federal and state affirmative action requirements, will not be shared with those involved in the hiring decision, and will not affect consideration of your application.

Ethnic Group:
Select only one.
A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.
Race:
Select one or more, as applicable.
A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
A person having origins in any of the black racial groups of Africa.
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
A person having origins in any of the original peoples of Europe, the middle East, or North Africa.
Sex:

Voluntary Applicant Veteran Self-Identification Form

This form invites applicants to self-identify as veterans under both the Vietnam Era Veterans' Readjustment Assistance Act (VEVRAA) and Oregon Veterans' Preference in Employment.

Under the Vietnam Era Veterans' Readjustment Assistance Act (VEVRAA), as amended, the University of Oregon is required to take affirmative action to employ and advance in employment veterans in the following classifications.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. Your Form DD-214 may help you make this determination. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be maintained confidentially and only be used in ways that are consistent with VEVRAA.



Under Oregon Veterans' Preference in Employment, certain veterans may be eligible for employment preference.  If you are a veteran or disabled veteran and would like to apply for the preference afforded under the Oregon Veterans' Preference statute, please complete the Veteran Status section below and submit the required documentation (see Note below) by the application deadline or review date indicated in the position posting.  If you are eligible for the veterans' preference, hiring departments will be notified of your status but will not receive this form or the supporting documentation. All eligible veterans are encouraged to apply for the Oregon Veterans Preference.

Veteran
Status

a person who (A) Served on active duty with the Armed Forces of the United States: (i) for a period of more than 90 consecutive days beginning on or before January 31, 1955, and was discharged or released under honorable conditions; (ii) for a period of more than 178 consecutive days beginning after January 31, 1955, and was discharged or released from active duty under honorable conditions; (iii) for 178 days or less and was discharged or released from active duty under honorable conditions because of a service-connected disability; (iv) for 178 days or less and was discharged or released from active duty under honorable conditions and has a disability rating from the United States Department of Veterans Affairs; or (v) for at least one day in a combat zone and was discharged or released from active duty under honorable conditions; (B) Received a combat or campaign ribbon or an expeditionary medal for service in the Armed Forces of the United States and was discharged or released from active duty under honorable conditions; or (C) Is receiving a nonservice-connected pension from the United States Department of Veterans Affairs.

a person who has a disability rating from the United States Department of Veterans Affairs, a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty, or a person who was awarded the Purple Heart for wounds received in combat.

NOTE: Veterans' Preference, as required under Oregon law, will not be applied without the appropriate documentation. Supporting documentation (DD214/DD215 and, for Disabled Veterans, a copy of your veteran's disability preference letter from the Department of Veterans Affairs unless that information is included in the DD214/215 form) MUST be submitted to Human Resources. To receive preference in connection with this search, this documentation must be received by the review/closing date on the posting. Materials can be scanned and forwarded electronically to adrf@uoregon.edu, faxed to 541-346-2548, or be sent via regular mail to: Human Resources, 677 E. 12th Ave. Suite 400, 5210 University of Oregon, Eugene, OR 97403-5210. Please be sure to include the Posting # with the supporting documentation. If you have any questions please call 541-346-3159.

Reasonable Accommodation Notice

If you are a disabled veteran or individual with a disability, please let us know if you need reasonable accommodation to participate in the hiring process or in employment if hired for this position. Please contact the Office of Affirmative Action & Equal Opportunity. Tel: (541) 346-3123; Fax: (541) 346-4168.

Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
Page 1 of 2
Why are you being asked to complete this page?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you have ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)
Please check one of the boxes below:




Your Name
09-21-2017
Today's Date
Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
Page 2 of 2
Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

______________________
i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.