Indiana University Kokomo

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2300 S. Washington St.
Kokomo, IN 46904-9003

Phone: (765) 453-2000

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INDIANA UNIVERSITY KOKOMO APPLICANT INFORMATION
Name:
Email:
Date:
Sex:	Male Female
Age:	under 40 over 40
Position Applied for:
Do you wish to identify your self as disabled?	Yes No
RESIDENT STATUS
In accordance with federal law. IU employs only U.S. citizens and noncitizens' authorized to work in this country. IU will assist individuals needing working authorization to obtain the visa status necessary to be employed here. Please indicated your present status.
U.S Citizen or Permanent Resident
Foreign National VISA type:
Are you Hispanic or Latino?	Yes No
RACE/ETHNICITY (select one)
Please select the race/races you consider yourself. (you may choose more than one)	White black or African American American Indiana Or Alaska Native Asian Native Hawaiian or Other Pacific Islander Multiracial
VETERAN STATUS
Do you qualify for consideration under Indiana University Affirmative Action Plan for Veterans? If so, choose one	Recently Separated Veteran Disabled Veteran Vietnam-era-Veteran Armed Forces Services Medal Veteran Other Protected Veteran
How did you learn of this position? (check all that apply)
Advertisement in newsletter, newspaper, magazine, or journal Hiring Department, professor or search committee member contacted me by phone, email, or direct mailing Electronic bulletin board/job listing or Web site Professional organization or meeting Personal contact or word of mouth from a relative, friend, or colleague I contacted the hiring department or faculty member regarding possible openings IU Bulletin for Academic Appointees or other IU Job list posted at I was reffered by a placement office at Recruitment/referral agency Other

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