University of Pennsylvania Staff Affirmative Action Compliance Form

University of Pennsylvania Staff Affirmative Action Compliance Form
The information provided on this form is used to document the University’s good faith efforts during the recruitment and
selection process and to affirm that the search was conducted in a manner that is consistent with relevant University
policies. Please see the reverse side of this form for further instructions and definitions.
I. POST AND SEARCH INFORMATION
Job Title___________________________________________
Reference No.______________________________________
School/Center_______________________________________
Department________________________________________
If advertisements were placed in addition to PeopleAdmin (newspapers, websites, etc.), please attach.
II. APPLICANTS INTERVIEWED
(See codes on reverse side of this form. Shaded areas are to be completed by the Staff Affirmative Action Compliance Officer.)
Total Number of Applications Received _________
Total Number of Applicants Interviewed ________
Total Number of Minorities ___________
Total Number of Women _____________
NAME
Total Number of Minorities____________
Total Number of Women______________
Sex
Hispanic/
Latino?
Race/Ethnicity
Interview
Method
Reason(s) Not
Recommended
Recommended Applicant
Reason (s) for selection of recommended candidate:_____________________________________________________________________
________________________________________________________________________________________________________________________
III. APPLICANT POOL DATA (IF SEARCH FIRM WAS RETAINED)
Please indicate the name of the search firm. _____________________________________________________________
Grand
Total
Total
Total
Female Minority
Hispanic/
Latino
Yes
No
M
F
American
Indian
Alaskan
Native
M
F
Asian
M
F
Black or
Native
African Hawaiian/
American
Pacific
Islander
M
F
M
F
White
M
F
Two or
More
Races
M
F
Unknown
M
IV. AUTHORIZING SIGNATURES
All persons signing this compliance form attest that a good faith effort was made to conduct the search and selection
process for this position in compliance with relevant University policies and procedures pertaining to filling vacancies
including equal opportunity/affirmative action.
________________________________________
________________
__________________________________________
__________________
Hiring Officer
Date
AA Compliance Officer
Date
updated July 2010
F
University of Pennsylvania Staff Affirmative Action Form
The hiring officer should complete and sign the form, and then forward it to the School or Center staff
affirmative action compliance officer for review and approval as evidenced by his or her signature. After the
compliance review, please submit the original signed form to Human Resources, provide a copy to the Office of
Affirmative Action, your compliance officer, and retain a copy for your records. If you have questions
regarding the affirmative action compliance process and/or the completion of this form, please contact the
Office of Affirmative Action and Equal Opportunity Programs at 215-898-6993 (voice), 215-898-7803 (TDD),
or [email protected]
The race and ethnicity definitions for federal reporting purposes are as follows:
S
Hispanic/Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin regardless of race.
B
Black or African American: A person having origins in any of the black racial groups of Africa.
P
Native Hawaiian or other Pacific Islander: A person having origins in any of the peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
C
White: A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa.
R
Asian: 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.
A
American Indian/Alaska Native: A person having origins in any of the original peoples of North
America and South America (including Central America), and who maintain tribal affiliation or
community attachment.
T
Two or More Races: All persons who identify with more than one of the above six races.
SEX
1. Female
2. Male
INTERVIEW METHOD
1. Interviewed by telephone
2. Interviewed by video conference
3. Interviewed in person
REASON NOT RECOMMENDED
1. Previous experience not as strong
2. Did not possess preferred educational level
3. Position related skills not as strong
4. Applicant salary requirement too high
5. Applicant declined interview
6. Applicant withdrew from consideration
7. Applicant rejected offer
8. Applicant declined position
9. Other (please provide explanation)
updated July 2010