Job Applicant Survey | International Institute of Minnesota

U.S. EQUAL EMPLOYMENT OPPORTUNITY SURVEY

Completion is voluntary and will not subject you to adverse treatment.

The International Institute of Minnesota values a diverse workplace and strongly encourages women, people of color, LGBTQ+ individuals, and New Americans to apply. IIMN is an equal opportunity employer. Applicants will not be discriminated against because of race, color, sex, sexual orientation, gender identity, age, religion, national origin, citizenship status, disability, or any protected category prohibited by local, state, or federal laws. We invite all applicants to voluntarily self-identify their race, ethnicity, and gender. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment. This information will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records, only accessed by the Human Resources department.

Race

Hispanic or Latino. (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race).

White – Not Hispanic or Latino. (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa).

Black or African American – Not Hispanic or Latino. (A person having origins in any of the black racial groups of Africa).

Native Hawaiian or Other Pacific Islander – Not Hispanic or Latino. (A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands).

Asian – Not Hispanic or Latino. (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam).

American Indian or Alaska Native – Not Hispanic or Latino. (A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment).

Two or More Races – Not Hispanic or Latino (All persons who identify with more than one of the above five races).

Decline to self-identify

Gender

Female

Male

Non-binary

I choose not to self-identify

Completion is voluntary and will not subject you to adverse treatment.

VOLUNTARY SELF-IDENTIFICATION OF DISABILITY

Form CC-305 / OMB Control Number 1250-0005 / Expires 04/30/2026

Q: Why are you being asked to complete this form?

A: We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

Q: How do you know if you have a disability?

A: A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes
Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn’s Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Disability Status

SELF-IDENTIFICATION OF VETERAN STATUS

Completion is voluntary and will not subject you to adverse treatment.

As a government contractor subject to the Section 4212 of the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, which requires Government contractors to take affirmative action to employ and advance in employment:

Veteran Status

Disabled veterans – A veteran who served on active duty in the U.S. military and is entitled to disability compensation (or who but for the receipt of military retired pay would be entitled to disability compensation) under laws administered by the Secretary of Veterans Affairs, or was discharged or released from active duty because of a service-connected disability.

Recently separated veteran – A veteran separated during the three-year period beginning on the date of the veteran’s discharge or release from active duty in the U.S military, ground, naval, or air service.

Active duty wartime or campaign badge veteran – A veteran who served on active duty in the U.S. military during a war, or in a campaign or expedition for which a campaign badge was authorized under the laws administered by the Department of Defense.

Armed forces service medal veteran – A veteran who, while serving on active duty in the U.S. military ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209).

If you believe that you belong to any of the categories of protected veterans, please indicate by making the appropriate selection.

Phone

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U.S. EQUAL EMPLOYMENT OPPORTUNITY SURVEY

VOLUNTARY SELF-IDENTIFICATION OF DISABILITY

SELF-IDENTIFICATION OF VETERAN STATUS