University of Arkansas at Little Rock

Thank you for your interest in a position at UALR. In our effort to meet federal and state guidelines UALR is required to collect Biographical data sheet information from applicants.Completing the form is voluntary.

This form must be completed for each position for which you have applied.

Position number: *

Title of the job:

Department where job is located:

First name:

Middle name:

Last name:

Last 5 digits of Social Security Number:

Date of birth:

Age:
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Gender:
Male
Female
Decline to disclose gender

Ethnicity:
Hispanic or Latino

Race:
White
Black/African American
Native Hawaiian or Other Pacific Islander
Asian
American Indian or Alaskan Native
Two or more races

Military Veteran Status:
N/ASpecial Disabled VeteranOther Protected VeteranArmed Forces Service Medal VeteranVietnam-Era

Military Veteran Separation Date (MM/DD/YYYY):

Indicate regional location of job announcement:
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To assist us in evaluating advertising effectiveness, please indicate how you learned of this vacancy:
(100 character limit)

Contact Karen Baker (knbaker@ualr.edu) for help with this form.