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Office of Diversity and Equal Opportunity 

Applicant Data Form

This data will be used for statistical purposes and shall not be used to illegally discriminate for or against anyone. Please complete all sections.

  1. Name:
    Last Name:
    First Name:
    Middle Name:

  2. For what vacancy are you applying?
    Position number:
    Title of Position:
    Department:

  3. How did you learn of this vacancy?
    Vacancy notice/bulletin board (Please Specify Below)
    Professional Journal/job listing (Please Specify Below)
    Newspaper/magazine (Please Specify Below)
    Web site (Please Specify Below)
    Other (Please Specify Below)

    Specify:

  4. Please indicate your gender:
    Male
    Female

  5. Race/Ethnicity (check only one):
    White – people of European (except Spanish), North African, Middle Eastern
    (i.e. – Turkey through Afghanistan) descent
    Black (all persons having origins in any of the Black African racial groups
    not of Hispanic origin)
    Hispanic (all persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Culture or origin regardless of race)
    Asian and Pacific Islander (all persons having origins in any of the original peoples of
    the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands)
    American Indian or Alaskan Native (all persons having origins in any of the original peoples of North America and maintaining identifiable tribal affiliations through
    membership and participation or community identification)

  6. Birthdate: (mm/dd/yyyy) / /

    Towson University is an equal opportunity/affirmative action employer and has a strong institutional commitment to diversity. Women, minorities, persons with disabilities and veterans are encouraged to apply.


   © 2008 • Towson University Last Updated: Tuesday, October 21, 2008   
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