Step 1 of 2 50% Position Applied for:*Choose a PositionSpecialty Medicine ChairDirector of Family MedicineDirector of Internal MedicineDirector of PediatricsAssistant/Associate Professor, OPPChair of Physiology, Pathology and PharmacologyAssistant/Associate Professor, AnatomyAssistant/Associate Professor, Biochemistry, Molecular and Cell SciencesAssistant/Associate Professor, Physiology, Pathology and PharmacologyAssistant/Associate Professor, Microbiology and ImmunologyAdministrative Assistant for the Office of Student AffairsReceptionistName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home PhoneMobile Phone*Email* To apply for this position, please attach a cover letter and resume’, or CV.* Drop files here or Accepted file types: pdf, doc, docx, rtf. Voluntary Applicant SurveyAs an Equal Opportunity employer, we gather demographic information both about our applicants and employees. Your assistance in this process would be most helpful. Participation is strictly voluntary and refusal to provide it will not subject you to any adverse treatment. When reported, the information you provide will not identify you as an individual, will remain confidential, and be used only to fulfill our EEO obligations. Please take a few moments to complete and return the survey.Other StatusDo you Self-Identify as a Veteran? Because Arkansas College of Osteopathic Medicine is an educational institution and we may administer federal funding for students we may potentially be considered as a Government contractor making us subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows: A “disabled veteran” is one of the following: A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability. A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service. An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. Please Check One*I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVEI AM NOT A PROTECTED VETERANI DECLINE TO SELF-IDENTIFYWhy are you being asked to complete this form? As an educational institutional we may administer federal funding for students making us potentially subject to particular requirements related to providing equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. 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Disabilities include, but are not limited to: Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation) Please check one of the boxes below*YES, I HAVE A DISABILITY (or previously had a disability)NO, I DON’T HAVE A DISABILITYI DECLINE TO SELF-IDENTIFYGender & EthnicityGender*MaleFemaleI decline to self-identify.Race/Ethnicity*White - A person with origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American - A person with 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.Native Hawaiian or Pacific Islander - A person with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian - A person with origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, Vietnam, Cambodia and Laos.American Indian or Alaska Native - A person with origins in the original peoples of North, Central, and South America, and who maintains tribal affiliation or community attachment.Two or More Races - All persons who identify with more than one of the above five races.I decline to self-identify.Please check the most appropriate race or ethnic group.Reasonable Accommodation Notice Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. 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