Affirmative Action Recruitment Summary Form
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1Texas Tech University System
EEO/ Affirmative Action Recruitment Summary
Proper completion of this form is a requirement of the TTUHSC Affirmative Action Programs
Must be completed for Faculty, Staff and Student Positions
Requisition #: ___________________________
Current Date: ___________________________
Candidate Selected: _________________________
Hire Date: ______________________________
Position Title: _________________________________ Salary: ________________________________
Position Details: (select only one)
Initial Appointment
Reappointment
New Position
Replacement
Replacing Employee ______________________________________
Race: _________ Gender: __________ Salary: _______________
List Recruitment advertising, contracts and correspondence used to generate candidates (if not included in the AA In-
Progress Review (Att. C):
Print/ Paper Advertising:
Local: ___________________________
State: _________________________________
National: _________________________
Online Sources:
List all sites where this position was advertised:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Personal Contacts: (Please detail all sources you reached out to for referrals)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
rd
Recruiting Firms/ 3
Party firms engaged in search:
__________________________________________________________________________________________________
Applicant Information (provided by the local HR office if available)
Total Number of Applicants: Men______
Female: ______
Blacks:______ Hispanics: ______
Asian/ Pacific Islanders:______
American Indians: ______
Disabled Persons:______
Veteran: ______
Number interviewed by class: Men______
Female: ______
Blacks:______ Hispanics: ______
Asian/ Pacific Islanders:______
American Indians: ______
Disabled Persons:______
Veteran: ______
Justification for hiring decision:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Provide name and reason for each candidate that declined an interview or declined job offer:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
_______________________________________
Signature of Department Head
Date
Signatures hereby certify that the employment action(s)
described above adhere to TTU HSC’s OP’s and EEO and
______________________________________________________
Signature of Administrative Official
Date
Affirmative Action policies and that all employment records
will be retained for five (5) years .
ATTACHMENT D
Page 1
HSC OP 60.09
December 30, 2014
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