EEO

The federal government requires the following information to be collected for statistical reporting as a part of the Affirmative Action program. Refusal to answer will not result in adverse treatment of any applicant. This information is not used in the employment process nor released in a manner which identifies the individual. This form will be removed prior to being forwarded to the hiring authority.

York Technical College does not discriminate on the basis of race, color, religion, sex, national origin, age or disability. York Technical College is an Equal Opportunity/Affirmative Action Employer.

NOTE: The information requested in this section is not used to evaluate your application. This information is needed to satisfy EEOC Reporting requirements, personnel research, and the State of South Carolina’s voluntary efforts to accommodate the special needs of disabled individuals.
NAME: DA (Last) (First) (Middle)		TODAY’S DATE: (Month) (Day) (Year)
DATE OF BIRTH: (Month) (Day) (Year)	SEX: ( ) Female ( ) Male
RACE (Check one): ( ) White ( ) Black ( ) Hispanic ( ) Asian or Pacific Islander ( ) American Indian or Alaskan Native
POSITION APPLIED FOR:
Will you need reasonable accommodations to participate in the selection procedures (e.g., interview, written tests, or job demonstration)? ( ) Yes ( ) No If yes, please specify:______________________________________________________________
Please check the source which caused you to apply: ___ College recruitment ___ Recommended by state employee ___ Television advertisement ___ Field Recruitment non/scholastic ___ Unsolicited application ___ Trade journal advertisement ___ Employment Security Commission ___ Newspaper advertisement ___ Other please specify ___ Other state agency ___ Radio advertisement __________________________

Authority to Release Information: By my signature, I consent to the release of information to duly authorized officers, agents and/or employees of the State of South Carolina which may include but not be limited to information concerning my past and present work including my official personnel files, attendance records, evaluations, educational records including transcripts, military service, law enforcement records and/or any personnel record deemed necessary, and to make inquiries if third parties such as credit bureaus. I further release the organization, educational entity, present and former employers, law enforcement organization and all third parties form any and all claims of whatever nature that I may have as a result of any inquiry or response given to such inquiries made in connection with my application for employment.

STUDENT LOAN: S.C. State law (59-111-50) prohibits State employment to persons who have defaulted on student loans unless proof that satisfactory arrangements have been made is provided. By my signature, I certify that I am not currently in default on a student loan.

Certification of Applicant: By my signature, I affirm, agree and/or understand that all statements on this form are true and accurate: any misrepresentation, falsification, or material omission of information or data on this application may result in exclusion from further consideration or, if hired, termination of employment; if I have requested herein that my present employer not be contacted, an offer of employment may be conditioned upon acceptable information and verification from such employer prior to beginning work; for those applications processed through the State Job Information System, copies of this form may be furnished to other State agencies, departments and institutions. If employed by the State, I agree to adhere to the State’s Drug Free policy.

State agencies are actively supporting the Family Independence Act by hiring welfare and food stamp recipients for certain jobs. Are you currently receiving AFDC benefits or food stamps? Yes ( ) No ( )