GRAMBLING STATE UNIVERSITY
SUPPLEMENTAL APPLICANT INFORMATION FORM
(VOLUNTARY INFORMATION)
EEO FORM #SA102


IF YOU ARE APPLYING FOR A POSITION AT GRAMBLING STATE UNIVERSITY, PLEASE COMPLETE THIS FORM.

Grambling State University is required by Federal Law to report specific information regarding our applicant pool. The information will be used exclusively for internal and external monitoring and reporting. Complete and return this form via email to: Bradleym@gram.edu or regular mail to: Grambling State University, EEO/Wage & Salary Office, P. O. Drawer 603, Grambling, LA 71245

NAME:

ADDRESS:

EMAIL ADDRESS:

POSITION APPLYING FOR:

ETHNIC ORIGIN: BLACK
WHITE
HISPANIC
AMERICAN INDIAN  OR ALASKAN NATIVE
ASIAN/PACIFIC ISLANDER
OTHER:

GENDER:     MALE     FEMALE

DISABILITY:     YES     NO

VETERAN STATUS:     VETERAN BEFORE 8/64      DISABLED
VIETNAM ERA VETERAN  NOT A VETERAN
VETERAN

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