The Office of Affirmative Action welcomes you to the Arkansas State University
workforce. You are invited to identify yourself voluntarily as a veteran and/or disabled person on the following
form. This will help the university assure equal opportunity/affirmative action in its employment practices.
All information will be kept confidential; the data collected will be used in its aggregate form for the annual veteran’s employment report and the university’s affirmative action report.
Both the Vietnam Era Veterans’ Readjustment Assistant Act of 1974, as amended (38 USC 4212), and the Rehabilitation Act of 1973, as amended (Section 503), provide specific policies for qualified protected veterans and qualified individuals with disabilities.
If you are a qualified protected veteran and would like to be considered under the university’s Affirmative Action Plan, or, if you have a disability and would like to be considered under the Americans with Disability Act, please tell us. You may inform us of your designation now or at any time in the future. This information will assist us in making accommodations which will assist you in your job duties.
PERSON WITH A DISABILITY means any person who a) has a physical or mental impairment which substantially limits one or more of such person’s major life activities, such as walking or speaking; b) has a record of such impairment or c) is regarded as having such an impairment.
VIETNAM-ERA VETERAN means any person who served on active military duty for a period of more than 180 days, any part of which occurred between August 5, 1964, and May 7, 1975, and was discharged or released with other than a dishonorable discharge
OTHER PROTECTED VETERAN means any other veteran who served on active duty in the Armed Forces during a war or in a campaign or expedition for which a campaign badge has been authorized
SPECIAL DISABLED VETERAN means a veteran who is entitled to compensation for a disability or a person who was discharged from active duty because of a service-connected disability
NEWLY-SEPARATED VETERAN means any veteran who began employment with ASU within one year of being discharged or released from active duty in the U.S. military, ground, naval or air service
I have read the aforementioned descriptions in this document and I further attest, by checking the appropriate space and signing below, that I am
a person
with a disability
a Vietnam-Era
veteran
an other
protected veteran
a special
disabled veteran
a
newly-separated veteran Discharge Date:
First
Name: Middle Initial:
Last Name:
Date:
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