DEPARTMENT OF DEFENSE DEPENDENTS SCHOOLS (DoDDS) VOLUNTARY QUESTIONNAIRE Form Approved OMB No. 0704-0223 Expires Jun 30, 2001 The public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports 3704-0223). 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202.4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid DMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. RETURN COMPLETED FORM TO: DEPARTMENT OF DEFENSE DEPENDENTS SCHOOLS, RECRUITMENT UNIT 4040 NORTH FAIRFAX DRIVE, ARLINGTON, VA 22203-I 634 GENERAL INFORMATION The information from this questionnaire is used to help insure that the Department of Defense Dependents Schools (DoDDS) personnel practices meet the requirements of Federal law. Your responses are voluntary. Any information you furnish will be used only for the purpose of producing statistical reports. There will be no consequence to you whether or not you furnish the information since it will not be used in any determination that affects you individually. This form will be maintained separately from your application materials. Furthermore, the statistical reports mentioned above will be in the form of aggregate totals and will not identify you in any way as an individual. Please read each item thoroughly before completing the appropriate code number in each box. QUESTIONNAIRE 1. HOW DID YOU LEARN ABOUT THE DODDS EMPLOYMENT OPPORTUNITIES? (You may select up to three choices.) _________ _________ ________ GENERAL PROFESSIONAL CONVENTIONS/MEETINGS 01 - Friend or relative working for DoDDS 02 - Friend or relative not working for DoDDS 03 - On-campus recruitment by DoDDS 37 - National Alliance of Black School Educators 38 - International Reading 04 - Direct mailing by DDDDS ' 39 - LULAC 05 - Government job-information center 06 - State employment office 07 - Private information office 08 - State rehabilitation center 40 - Association for Childhood Education International 41 - American Vocational Association 42 - Council for Exceptional Children 09 - Veterans association/employment office 10 - School placement officer PROFESSIONAL JOURNALS 11 - Exceptional Children 12 - Instructor 17 - Business Education Forum 18 - Creative Classroom 19 - TESOL Newsletter 20 - Black Collegian 21 - Career Opportunities for Minority College Graduates 22 - Learning Magazine 23 - American Libraries 24 - Crisis 13 - The Mathematics Teacher 14 - AAR/EEO Register 15 - Black EOE Journal 16 - Black Issues in Higher Education 43 - National Science Teachers Association 44 - American Speech - Language - Hearing Association 45 - National Council of Teachers of Mathematics 46 - National Business Education Association 47 - TESOL 48 - University of Northern Iowa - Recruiting Fair 49 - NAACP 50 - Association for School Librarians 61 - American Librarian Association 5 2 -IMAGE 53 - National Art Education Association 54 - UCLA - Recruiting Fair 55 - Ohio State University - Recruiting Fair 66 - Learning Disabilities Association of America 57 - National Association for Gifted Children 25 - Florida Leader 26 - Golden Gater 27 - Hispanic Register 28 - Hispanic Times 29 - LULAC News 30 - Native American Connect 31 - Native American Smoke Signal 32 - Center of East Asian Studies 33 - National Advisory Council on Indian Educators 34 - National Alliance of Black School Educators 35 - Pine Needle 36 - Other (Specify) 58 - National Association of Biology Teachers 59 - National Council of Teachers of English 60 - Association of Supervision and Curriculum Development 61 - Northeast Conference of the Teaching of Foreign Language 62 - SER Jobs for Progress 63 - American School Counselor Association 64 - National Education Association 65 - Other (Specify) DS FORM 5012, JUN 1998 REPLACES SD FORM 779, SEP 91, WHICH IS OBSOLETE. Designed using Perform Pro, WHS/DIOR, Jun 98 DEPARTMENT OF DEFENSE DEPENDENTS SCHOOLS VOLUNTARY QUESTIONNAIRE (Continued) 2. RACE AND SEX. Please identify yourself in terms of the race and sex categories below. First read definitions of subcategories. CATEGORIES AND DEFINITIONS The minimum categories for data on race and ethnicity for Federal statistics, program administrative reporting, and civil rights compliance reporting are defined as follows: - 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 maintains tribal affiliation or community attachment. - 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. - Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American." - Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino." - Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. - White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. a. RACE 1 - American Indian or Alaska Native 2 - Asian 3 - Black or African American 4 - Hispanic or Latin0 5. Native Hawaiian or Other Pacific Islander 6 - White b. SEX M - Male F - Female 3. REPORTABLE DISABILITY. A physical or mental disability is NOT determined by a person's ability to perform his or her work but by a disability, or a history of such disability, which is likely to cause the employee to experience difficulty in obtaining, maintaining or advancing in employment. This does not apply solely to an employee's current position, but applies to the total career life cycle of that employee. (In the case of multiple disabilities, choose the code which describes the impairment that would most likely result in such difficulties.) Do you have any physical disability? If "Yes", enter 1 If "No", enter 2 FORM 5012 (BACK), JUN 1998