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Applicant Information Survey


Thank you for your application for employment with Stony Brook University.

Stony Brook University is an Equal Opportunity and Affirmative Action employer and educator. Qualified applicants are considered for employment without regard to race, color, religion, national or ethnic origin, age, genetic information, sex, creed, marital status, gender identity, sexual orientation, disability, veteran or military status.

As a government contractor, Stony Brook University is required to request and maintain data on applicants to ensure our compliance with EEO/AA laws and regulations. In our effort to comply, we invite you to voluntarily self-identify your information requested below.  Completion of this form is voluntary and in no way affects the decision regarding your employment opportunity.  The information provided will be held in the strictest confidence.

Note: please make sure you include the information requested below:

Please select the applicable categories.


 


Definition of Race / Ethnic Groups

  • Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
  • White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
  • Black or African American - A person having origins in any of the black racial groups of Africa.
  • Native Hawaiian or Other Pacific Islander - A person having origins in any way of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
  • 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.
  • American Indian or Alaska Native - 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.

 

Survey of Protected Veteran Status


 

Stony Brook University is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 ("VEVRAA"), which requires Government contractors to take affirmative action to employ and advance in employment:

  1. Disabled veterans;
  2. Recently separated veterans;
  3. Active duty wartime or campaign badge veterans; and
  4. Armed Forces service medal veterans.

As a Government contractor subject to VEVRAA, we are required to submit a report to the U.S. Department of Labor each year identifying the number of our employees who are "protected veteran" belonging to the below classifications.

Protected Veteran Classifications are defined as below:

  • A " disabled veteran" is one of the following:
    • A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
    • A person who was discharged or related from active duty because of a service-connected disability.
  • A " recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
  • An " active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. (Period of War Dates: Korean Conflict June 27, 1950 - January 31, 1955; Vietnam Era February 28, 1961 - May 7 1975 for veterans serving in the Republic of Vietnam or August 5, 1964 - May 7, 1975 for all other cases; Persian Gulf War August 2, 1990 - present)
  • An " Armed forces service medal veteran" means 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.



If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistant Act of 1974, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

This Company abides by the requirements of 41 CFR 60-300.5(a). This regulation requires affirmative action by covered contractors to employ and advance in employment qualified protected veterans.

 


 

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020

 

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities i. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

 

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation) 

 

 

 


Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternative format, using a sign language interpreter, or using specialized equipment.


i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/offcp.

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.


Information for Requesting Information About An Accommodation

For Information about reasonable accommodation procedures: http://www.stonybrook.edu/commcms/oide-accessibility

Stony Brook University has appointed the following individuals as the official responsible for processing request for reasonable accommodation from applicants and employees with disabilities:

Stony Brook University and Research Foundation Human Resources Services Stony Brook University Hospital Human Resources LI State Veterans Home Human Resources
Name: Paulene Toussaint
Phone:
(631) 632-6161
Fax:
(631) 632-6208
Email: hrs_benefits@stonybrook.edu
Name: Tami Goldberg
Phone:
(631) 444-4734
Fax:
(631) 444-4724
Email: tami.goldberg@stonybrook.edu
Name: Denis Muscarella
Phone:
(631) 444-8617
Fax:
(631) 444-8517
Email: lisvhhr@stonybrook.edu
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