Ethnicity (check one):

___ ASIAN

Chinese, East Indian, Japanese, Korean, Laotian,

Cambodian, Vietnamese, Other Asian

___ BLACK (African-American)

___ FILIPINO

___ HISPANIC

Central American, Mexican/Mexican-American,

Chicano, South American, Other Hispanic

___ AMERICAN INDIAN/ALASKAN NATIVE

___ PACIFIC ISLANDER

Guamanian, Hawaiian, Samoan, Pacific Islander

___ WHITE (Non-Hispanic)

Disability

The Americans with Disabilities Act

states that a disabled person is anyone

who: (1) has a physical or mental

impairment which substantially limits one

or more major life activities; (2) has a

record of such impairment; or (3) is

regarded as having such an impairment.

Do you have a disability? Yes ___ No ___

If you have a disability and require

reasonable accommodation with our

selection process, contact Personnel Services

at 468-3062, Room 105