Lakehead University Canada Research Chair Self-Identification Form 

Lakehead University is strongly committed to equity, diversity and inclusion within our community and to developing an inclusive work environment that reflects the diversity of the broader populations that we serve. The University actively encourages applications from individuals representing equity-deserving groups, including women, racialized individuals, Indigenous persons, persons with disabilities, persons of any sexual orientation, gender identity or gender expression, with specific consideration given to women and gender minorities who self-identify in the recruitment process to further our equity, diversity and inclusion goals. 


Part of our equity, diversity and inclusion strategy means ensuring our hiring practices reflect our commitment to employment equity. In order to do this, we ask you to complete the following brief Self-Identification Survey as part of the Canada Research Chair application process.  All applicants for the Canada Research Chairs Program must include this self-identification form as an application requirement. However, if you would prefer not to self-identify and/or provide the requested information, you may select “I prefer not to answer" for any or all of the questions.  These questions come from the Canada Research Chair Program itself and are required to complete an application.


Your data will be collected, used, disclosed and retained in accordance with the Privacy Act. It may be used for the purposes of Program operations (including recruitment for merit review processes, where applicable), planning, performance measurement and monitoring, evaluation, and audits, and in aggregate form to report to the government or to the public. Self-identification statistics will always be reported in aggregate form to ensure the protection of the identity of any individual (not applicable in targeted hiring). 


As part of the Canada Research Chair Program, Lakehead University must meet equity targets as set out by the Program. When equity targets are not met, the Program restricts nominations to nominees who have self-identified as a member of one or more of the four designated groups (women and gender minorities, persons with disabilities, Indigenous peoples and racialized individuals). Where the nominating institution has met its equity targets, there are no such restrictions. The information you provide will also be used to track the number of applications received from members of the designated groups and will be used to report overall statistics to the Canada Research Chair Program. Your responses may also be used in the selection of candidates for employment. However, only individuals who qualify for the position will be considered. Your responses will be kept confidential unless you choose to share your responses with the Search Committee. 


You have the right to review and change information relating to you at any time, including “I prefer not to answer”. If you have any questions, please contact Dr. Jocelyn Bel, Equity, Diversity and Inclusion Research Facilitator at edi.research@lakeheadu.ca


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Email *
Contact Information
First Name *
Last Name *
Current Address *
Credentials 
What is the date of completion of your PhD or Equivalent?
 *
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University of Completion of PhD or Equivalent:
 *
Self-Identification Questions 
For the option of "Other", if you wish, please indicate how you identify for each of the following questions
What is your Date of Birth? *
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DD
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YYYY
Gender Identity: Please select the option that best describes your current gender identity *
Required
Sexual Orientation: Please select the sexual orientation that best describes how you currently think of yourself *
Required
Indigenous Identity 
Do you identify as Indigenous, that is, First Nation (North American Indian), Métis or Inuk (Inuit)? *
If "Yes", please select the group(s) that you identify with
Visible Minorities: 
The Employment Equity Act defines visible minorities as “persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour”
Do you identify as a member of a visible minority in Canada? *
Please select the population group(s) you identify with 
Note: if you answered “Yes” to the question about Indigenous Identity (i.e., you are an Indigenous person), select “Population group not listed above” for this question. You can also select from the list any other population group that applies to you
Disabilities: 
The Accessible Canada Act defines disability as “any impairment, including a physical, mental, intellectual, cognitive, learning, communication or sensory impairment—or a functional limitation—whether permanent, temporary or episodic in nature, or evident or not, that, in interaction with a barrier, hinders a person’s full and equal participation in society"
Do you identify as a person with a disability as described in the Act?
 *
If “Yes”, select the type(s) of disabilities that applies to you
Language: 
What language(s) did you first learn at home in childhood and still understand (Select all that apply) *
Required
What language(s) do you speak most often at home (Select all that apply)
Special Program: 
Please note: this application is a special program under the Ontario Human Rights Commission in order to meet equity targets outlined by the Canada Research Chair Program. As such, this appointment is open only to qualified individuals who self-identify as women or gender minorities.
Do you identify as a woman or a gender minority? *
Share Information with the Search Committee
You may wish to advise the CRC Search Committee of your status as a member of a designated group, in addition to sharing that you belong to the group of women and gender minorities (indicated above under the special program section). Please indicate below if you wish to forward your other responses regarding self-identification to the Chair of the Search Committee.
I wish to have my other self-identification responses forwarded to the Search Committee *
Comments/Suggestions
If you have any comments or suggestions about the self-identification questionnaire, please leave them below (Maximum character count: 1500)
A copy of your responses will be emailed to the address you provided.
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