Nort
h Iow
a Are
a Com
m
unity C
ollege
Ap
plicant D
ata Rec
ord
North
I
owa
A
rea C
om
m
unity
C
olleg
e
will
prov
ide
equal
oppo
rtunity
to
all
em
ploy
ees
and
applican
ts for
em
ploy
m
ent
in acc
ordan
c
e
w
i
t
h
all app
licable E
qual
Em
ploy
m
ent O
pportu
nity
and
A
ffirm
ativ
e A
ction
laws,
directiv
es an
d
reg
ulations
of fed
eral,
state,
and
local g
ov
erning
bo
dies a
nd
ag
encies.
I
ndiv
iduals
who
file a
n ap
plication
with
the C
olleg
e w
ill be g
iv
en c
onside
ration
for em
ploy
m
ent if
they
m
eet or
exceed
the
qualification
s set
by
the
board
, a
dm
inistration,
and
State
D
epartm
ent o
f
Edu
cation
for
the cla
ss or
position
for w
hich they
app
ly
. I
n em
ploy
ing
colleg
e pe
rsonne
l, th
e bo
ard w
ill cons
ider th
e qu
alifications,
cred
entials,
and
records
of the
app
licants w
ithout
reg
ard to
race,
colo
r, c
reed,
sex
, m
arital status
, n
ational
orig
in,
relig
ion,
ag
e,
or
disability
. I
n k
eeping
w
ith the
law,
the
board
w
ill cons
ider th
e v
eteran
status o
f app
licants.
The
d
a
t
a
r
e
qu
e
s
t
e
d is
for pe
riodic
g
ov
ernm
ent rep
orting
and
w
ill be
k
ept in
a
Con
fidential
File s
eparate
from
the
App
lication
for E
m
ploy
m
ent.
Thank
y
ou
for y
our
coop
eration.
(
PLEA
SE
PR
I
N
T)
D
at
e
__
____
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____
Position A
pplied
for
__
____
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____
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____
____
____
Referral S
ourc
e:
_
_
_
A
d
ve
r
t
i
s
e
me
n
t
_
_
_
F
r
i
e
n
d
_
_
_
R
e
l
a
t
i
ve
_
_
_
W
a
l
k-In
___E
m
ploy
m
ent A
g
ency
___WE
B
___N
I
AC
C
Em
ploy
ee
___O
ther
N
am
e
____
____
____
____
____
____
____
____
____
____
Phone
____
____
____
____
____
____
____
__
Last
First
Middle
Area
Cod
e
Ad
dress
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
S
tr
ee
t
C
it
y
S
ta
te
Z
ip
Voluntary Su
rvey
G
over
nment
ag
enc
i
es
at
t
i
mes
r
equi
r
e per
i
od
i
c r
eport
s
on t
he
s
ex,
et
hn
i
c gr
oup,
di
s
abi
l
i
t
y
,
ac
t
i
ve
dut
y
ve
t
er
an
and ot
her
prot
ect
ed
st
at
us
o
f
ap
p
l
i
cant
s.
T
hi
s
d
at
a i
s
f
o
r anal
y
si
s
and
po
ss
i
b
l
e af
f
i
rma
t
i
ve act
i
o
n only
.
SU
B
M
ISS
IO
N
O
F
I
N
F
O
R
M
A
T
IO
N
IS
V
O
L
U
N
T
A
R
Y
.
Ch
eck
one:
__
_
F
em
al
e
_
__
Ma
le
Ch
eck
one:
Hisp
anic o
r La
tino
Yes
No
An
d (if app
licable)
check
on
e or
more
of the follow
ing
racial
grou
ps:
___
Am
erican
I
ndian/A
lask
an N
ativ
e
___
Asian
Black
or
African
A
m
erican
__
_
N
at
iv
e
H
aw
ai
ia
n/
O
th
er
P
ac
if
ic
I
sl
an
de
r
__
_W
hi
te
Ch
eck
if
an
y o
f
the
follow
ing
are
app
licable:
__
_ Ac
t
i
ve Du
t
y Ve
t
e
r
a
n
__
_ P
e
r
s
on
wi
t
h d
i
s
a
bi
l
i
t
y
Retu
rn
in a
sep
arate
enve
lope
to:
No
r
t
h Iowa
Ar
e
a
Co
mm
un
i
t
y Col
l
e
ge
E
qu
al
O
pp
or
tu
ni
ty
/A
ff
ir
m
at
iv
e
A
ct
io
n
R
ep
or
t
50
0 C
ol
l
e
ge Dr
i
ve
Mason
City
, I
A
5040
1
U
pda
te
d 2/
23/
09