Voluntary Self Identification of Disability Form

Office of Human Resources and Student Employment

Voluntary Self Identification of Disability Form

Welcome

The Office of Human Resources and Student Employment is committed to providing excellence in leadership, direction, and assistance to the University's faculty and staff across all employment services, from the recruitment and selection of new employees through the retirement processing of employees completing their careers. The staff promotes a positive and welcoming work environment for University employees by proactive and creative problem-solving and by providing continuous opportunities for growth and development. The office places strong emphasis on supporting the University's teaching, research, and public service missions.

First Name(Required)

Last Name(Required)

Banner ID #(Required)

McNeese Email Address(Required)

Enter Email Confirm Email

Why are you being asked to complete this form?

As an executive branch state agency, the McNeese State University is required by La. R.S. 46:2597 to establish annual strategies and goals related to employment of individuals with disabilities. In order to effectively measure and report our progress to this end, La. R.S. 46:2597 requires us to ask employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five (5) years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so (if applicable). Your answer will be maintained confidentially and will not be seen by hiring officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way. For more information about this form or the Americans with Disabilities Act, visit the Office of the State Americans with Disabilities Act (ADA) Coordinator’s website at https://www.doa.la.gov/office-of-state-ada-coordinator/

How do you know if you have a disability?

You are considered to have a disability if you have a physical or mental impairment that substantially limits a major life activity, or if you have a history or record of such an impairment. Disabilities include, but are not limited, to:

Autism
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
Blind or low vision
Cancer
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or hard of hearing
Depression or anxiety
Diabetes
Epilepsy
Gastrointestinal disorders, for example, Crohn’s disease, or irritable bowel syndrome
Intellectual disability
Missing limbs or partially missing limbs
Nervous system condition, for example, migraine headaches, Parkinson’s disease or Multiple Sclerosis (MS)
Psychiatric condition, for example, bipolar disorder, schizophrenia, Post Traumatic Stress Disorder (PTSD) or major depression

Please choose ONE of the options below(Required)

YES, I have a disability

NO, I do not have a disability

I do not wish to answer

Date(Required)

Employee Signature(Required)

Voluntary Self Identification of Disability Form

Office of Human Resources and Student Employment

Voluntary Self Identification of Disability Form

Welcome

Why are you being asked to complete this form?

How do you know if you have a disability?

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