Personal Data Form

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Personal Data Form

Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment.
Some of the information requested on this form will be used for EEO-1 reporting purposes, and is labeled as such. If you choose not to self-identify your race/ethnicity at this time, the federal government requires Saint Mary's College of California to determine this information by visual survey and/or other available information.
All information provided will be kept separate from all other personnel records and only accessed by the Human Resources department.

Email *

Name

Personal email address

To authorize release of your phone # and/or address to students, faculty, or staff, indicate below:

Emergency Contact (Name)

Emergency Contact (Relationship)

Emergency Contact (Phone #)

U.S. Citizen

If you answered no to the previous question, please provide the name of the country that you are a citizen of:

Are you Hispanic or Latino

(Needed for EEO-1 reporting) Regardless of your answer to the prior question, please check one or more of the following groups that you consider yourself to be a member:

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.Option 2

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.

Asian (Not Hispanic or Latino): 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.

Native American or Alaska Native (Not Hispanic or Latino): 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.

Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.

Decline to state

(Needed for EEO-1 reporting) Gender

Gender Identity

Personal Pronoun

Sexual Orientation

Marital Status

Religious Affiliation

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