Applicant Data Form

Name:
Last Name:
First Name:
Middle Name:

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

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:

Please indicate your gender:
Male
Female
I chose not to disclose

Indicate Ethnic group (check only one):
Hispanic or Latino
Not Hispanic or Latino
I chose not to disclose

Indicate your Race (check only one):
White (Not Hispanic or Latino)
Black or African-American (Not Hispanic or Latino)
Asian (Not Hispanic or Latino)
American Indian or Alaskan Native (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
Two or more Races (Not Hispanic or Latino)
I chose not to disclose

Ethnic and Race Description

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.

Office of Diversity and Equal Opportunity