DIVISION OF RESEARCH
State University of New York at Binghamton
Affirmative Action Effort Report for Research Foundation Payroll
Please submit three copies to the Affirmative Action Office. One copy will be
sent to both the Research Foundation Office, and the project director's office.
(NOTE: This is a two-sided form)
Date:
From: , Project Director
(Name) (Title)
(Department) (Research Foundation Project Number)
Title of Position Being Filled:
Salary: $ Effective Date:
1. Please complete the following: Total Applicants Interviewed
Male Female Male Female
Black (Non-Hispanic Origin)
Hispanic (Mexican, Puerto Rican,
Cuban, South American, or other
Spanish culture or origin)
American Indian or Alaskan Native
Asian or Pacific Islander
White (Non-Hispanic Origin)
Non Citizen
2. Name of the person to be hired: Gender:
3. Racial / Ethnic Category of the person to be hired:
(use category listed in 1)
4. Is the person to be hired a Vietnam Veteran? Yes No Unknown
5. From which of the following areas was this individual recruited?
Binghamton/Broome County Elsewhere in NY State Outside NY State
6. Please attach the individual's resume.
PO Box 6000, Binghamton, NY, 13902-6000. Ph: 607-777- 4905
FORM Revised 6/07/04
7. If the person to be hired is not a woman, please indicate the difficulties you encountered which prevented
you from choosing a woman.
If the person is not a member of a minority group, please indicate the difficulties you encountered which
prevented you from choosing a minority person for the position.
8. Approved, with no further suggestions.
Approved, if the following suggestions are incorporated:
Assistant to the President for Affirmative Action Date
PO Box 6000, Binghamton, NY, 13902-6000. Ph: 607-777- 4905
FORM Revised 6/07/04