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Supplemental Protected Class Information Form

Human Resources Home Page  |  Anoka-Ramsey Community College Job Postings

Please consider completing the Supplemental Protected Class Information form (optional). See the Important Facts about this form at the bottom of this page. This form is not required to be considered for a position. This information will be kept separate from your file, and will not be provided to the screening committee.

You may also mail the Supplemental Protected Class Information form separately to the Affirmative Action Officer.

Affirmative Action Officer
Anoka-Ramsey Community College
11200 Mississippi Blvd NW
Coon Rapids, MN 55433-3499

Simply complete the form fields below, and click the Show Form button to display a printable version of the information.

Name Gender 
Position Applied For    Full Time?  
Are you a person with a disability? *
Racial/Ethnic Group:
American Indian **/Alaskan Native. Persons having origins in any of the original peoples of North America, and who maintain current identification through tribal affiliation or community recognition.
White not of Hispanic origin. Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black not of Hispanic origin. Persons having origins in any of the original non-white peoples of Africa.
Asian/Pacific Islander Persons having origins in any of the original peoples of the Far East, Southeast Asia, Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, India, and the Philippine Islands, and Samoa.
Hispanic Persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origins.
Other  

Veterans Preference:

Note: You will be required to provide proof of the Veterans Preference you claim before you are hired. To qualify for Veterans Preference, you must meet all of the following:

1. Have separated under honorable conditions from any branch of the Armed Forces of the United States;
2. Have served on active duty for 181 consecutive days or more or for the full period ordered to active duty OR have separated by reason of disability incurred while serving on active duty;
3. Be a United States citizen or resident alien.
I am not a veteran
I am a non-disabled veteran
I am a disabled veteran with a currently existing, compensable, service-connected disability as judged by the US Veteran’s Administration or by the Retirement Board of the Branches of the Armed Forces
I am the widow/widower (not remarried) of a deceased veteran
I am the spouse of a disabled veteran who cannot qualify because of the disability Recently Separated Veteran
 

To qualify as a recently separated veteran, you must:

1. Meet all the requirements for Veterans Preference above and
2. Have served in active military service at any time on or after September 11, 2001 as shown on your DD-214

Note: If invited to interview, you will be required to present your DD-214 to verify that you meet the recently separated veteran requirement.
I am a recently separated veteran
 
How did you learn about the job for which you applied? Please check all that apply.
Referred by a MN Community College System employee
Newspaper Ad (name of paper: )
University or college placement bureau (name/location )
Other (please specify )
Higheredjobs.com
* NOTE: by statute, "Disability/handicap" is defined as "a handicapping condition which substantially limits one of life's major activities, such as walking, caring for yourself, seeing, hearing, speaking, performing manual tasks, breathing, learning, working." Do not answer "yes" to this question if, for example, you have a visual problem corrected by glasses.
** NOTE: Minn. Stat. 254A.02, Subd. 11 defines American Indian status as: "American Indian means person of one-quarter or more Indian blood." The Minnesota Indian Affairs Council suggests that at the time of employment, state agencies require persons claiming Indian heritage to provide an enrollment number and tribal affiliation.

Important facts about information on your application

This application is to assist in the process of considering you for possible employment in the position listed. Certain information requested on this application is private. That is, it may be released only to you or to campuses where you may be considered for employment (to comply with M.S. 13.04, Subd. 2). If you are employed, the data will be available to the Dept. of Finance, the Dept. of Employee Relations, the Internal Revenue Service, and the Social Security Administration for payroll and tax purposes. If you disagree with the data we maintain about you, notify the Minnesota Community College System Human Resources Office in writing.

Reminder: Please contact the college Human Resources Office to identify any special needs you may have during the selection process. We will provide necessary reasonable accommodations.

 

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