U.S. Equal Opportunity Employment Information (Completion is voluntary) Individuals seeking employment are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, or sexual orientation. You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
Ethnicity and Race Identification If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows: A disabled veteran is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability. A recently separated veteran means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service. An active duty wartime or campaign badge veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An Armed forces service medal veteran means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Voluntary Self-Identification of Disability Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.1 To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you 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 all that apply)
Please provide high school name, address, major, credits earned or degree conferred
Please check all that apply.
Please provide college/university name, address, major, credits earned or degree conferred.
Please provide name, address, license or certificate
Please provide information for all employment within the past 10 years, starting with the most recent employer. Account for all periods including unemployment and service in the armed forces. Do not substitute a resume for this section.
Provide general Job-Relevant Information AND Computer Hardware and/or Software; Other Tools and Equipment.
Please list Position, Department and Dates.
Please provide the Name, Company, Position, Address, Telephone Number, Email Address, Work Relationship, No. of years known, and may we contact this individual.
The following statement is a part of the application. Read carefully before signing. I certify that the answers I have made to all of the questions in this application are true and complete to the best of my knowledge. I understand that any material omission, misrepresentation or falsification of this information is sufficient cause for rejection of my application or termination of my employment. I understand that any offer of employment is conditional upon proof of legal authorization to work in the United States as required by the Immigration Reform and Control Act. I hereby authorize representatives of Lakeland Community College to obtain background information about me including but not limited to verification of education, investigation of present and past employment, and review of criminal convictions. I also give consent for representatives of Lakeland Community College to obtain a Driver’s Abstract Report from a state in which I have held a standard or commercial driver’s license in the past five years if driving is an essential function of the position. I understand that I may be considered ineligible for employment if my driving record does not meet the standards of Lakeland Community College and/or its insurer. I release Lakeland Community College and its representatives from liability for seeking such information and all sources for furnishing such information. When submitting this application electronically, checking the box is an acceptable substitute for your signature. Lakeland Community College is an equal access and equal opportunity employer. We have a strong commitment to the principle of diversity and, in that spirit, seek a broad spectrum of candidates including women, minorities, people with disabilities and people over 40. Under-represented groups are encouraged to apply. If your disability requires special accommodations to participate in the application/interview process, contact the Human Resources Office at 440-525-7575.
