Form Ag 425 PDF Details

Form Ag 425 is a petition for relief filed with the Office of Administrative Hearings. The form is used by individuals or businesses who have been affected by an administrative order or decision. Form Ag 425 can be used to request a hearing, to ask for the order or decision to be amended, or to appeal the order or decision. Individuals or businesses who wish to file a Form Ag 425 should contact an attorney to ensure they are completing the form correctly.

QuestionAnswer
Form NameForm Ag 425
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesag 425 self identification form texas

Form Preview Example

AG-425 (09/17/12)

Texas A&M AgriLife

Administrative Services – Human Resources

VOLUNTARY SELF IDENTIFICATION, EEO FORM

The information requested is being collected for the purpose of reporting to federal, state and equal employment opportunity agencies and will

.

not be considered as part of the application for employment. It will be separated from the application. Your response is voluntary

LAST NAME

Address

 

 

FIRST NAME

 

 

 

 

 

 

MI

 

 

 

 

 

 

 

 

City

 

 

State

 

Zip Code

 

Phone

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

( )

 

 

 

 

 

 

 

 

 

 

 

 

Male

Female

Position title for which you are applying:_____________________________________________

Unit/Dept. for position:___________________________________________________________

Select all the following categories with which you identify:

WHITE (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (not Hispanic or Latino) - A person having origins in any of the Black racial groups of Africa.

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Asian (not Hispanic or Latino) - 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.

America Indian or Alaska Native (not Hispanic or Latino) - 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.

Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Two or More Races (not Hispanic or Latino) - A person who identifies with more than one of the above races.

MILITARY SERVICE

Are you a veteran? Yes

No

If yes, list type of discharge status:_______________________________________

 

Dates of service (from/to): ____________________ to ____________________

Are you a surviving spouse of a veteran?

Yes

No

Are you a surviving orphan of a veteran?

Yes

No

If yes, complete dates of service for veteran (from/to): _________________ to _________________

Signature_______________________________________________________ Date______________________________________

For questions concerning this form, please call 979-845-2423.

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