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BACKGROUND SURVEY QUESTIONNAIRE
THE LIBRARY OF CONGRESS
Human Resources Operations
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NOTE: Your cooperation is requested in completing
the following background and survey questionnaire and returning
it with your application. This form is STRICTLY CONFIDENTIAL and
will be used for statistical purposes only. All questionnaires
become the property of the directorate of Human Resources and
are not used in the evaluation process.
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INSTRUCTIONS
The information from this survey is used to help insure that Library
of Congress personnel practices meet the requirements of Federal law.
Your responses are voluntary. Answer each question to the best of your
ability. Read each item thoroughly before entering the appropriate code
number in each box.
Please print entries in dark ink. USE ONLY CAPITAL LETTERS.
NOTICE
Purpose and Routine Uses
The information from this survey is used for personnel and EEO research
to help insure that Library of Congress personnel practices meet the requirements
of Federal law.
Effects of Nondisclosure
Providing this information is voluntary. No individual personnel selections
are made based on this this information.
| NAME (last, first, middle initial)
_____________________________
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DATE (month/day/year)
_____________________________
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| 1. Social Security Number
|___|___|___| |___|___| |___|___|___|___|
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2. Date of Birth
_____________________________
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3. How do you usually learn about vacancies at the Library of Congress?
(You may select up to three choices. Enter the appropriate code numbers in the
boxes below.)
_________ _________ _________
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|____|____| |____|____| |____|____|
01 - Federal Research Services
Federal Career Opportunities
02 - Other Private Information Services
03 - Newspaper Ad
If yes, please specify:
04 - Magazine Ad
If yes, please specify:
05 - Professional Journal
If yes, please specify:
06 - Radio/TV
07 - Private Employment Office
08 - State Employment Office
09 - Minority or Other Special
Recruitment Sources
If yes, please specify:
10 - Library of Congress Recruitment at School or College
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11 - School or College Counselor or Other Official
12 - Federal, State or Local Job Information Center
13 - Religious Organization
14 - Friend or Relative Working at Library of Congress
15 - Friend or Relative Not Working at Library of Congress
16 - Professional Association
If yes, please specify:
17 - Vacancy Announcement Posted on Library of Congress Bulletin Boards
18 - Vacancy Announcements Circulated to Other Federal Agencies
19 - Vacancy Announcements Circulated to Library Schools
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20 - LC Vacancy Announcement: Received in Mail
21 - Telephone Calls to the Library of Congress Recruitment and Placement
Office
22 - Library of Congress Employment Hotline
23 - Other (specify) ________
24 - U.S. Office of Personnel Management's Website
25 - Monstor.com Website
26 - Other Website or Listserv If yes, please specify:
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4. Please categorize yourself in terms of race, sex, and ethnic categories
below. First read definitions of subcategories.
DEFINITIONS
The racial and ethnic categories for Federal statistics and administrative
reporting are defined as follows:
ETHNICITY
- HISPANIC. A person of Mexican, Puerto Rican, Cuban, Central or South American,
or other Spanish culture or origin, regardless of race.
RACE
- AMERICAN INDIAN OR ALASKAN NATIVE. A person having origins in any of the
original peoples of North America, and who maintains cultural identification
through tribal affiliation or community recognition.
- ASIAN OR PACIFIC ISLANDER. A person having origins in any of the original
peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific
Islands. This area includes, for example, China, India, Japan, Korea, the
Philippine Islands, and Samoa.
- BLACK. A person having origins in any of the black racial groups of Africa.
- WHITE. A person having origins in any of the original peoples of Europe,
North Africa, or the Middle East.
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A. Race
1 - American Indian or Alaskan native
2 - Asian or Pacific Islander
3 - Black
4 - White
5 - Other (Specify)
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B. Sex
1 - Male
2 - Female
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C. Ethnicity
1 - Hispanic Origin
2 - Not of Hispanic Origin
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