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Affirmative Action: Post-Offer Invitation to Self-Identify as a Veteran (VEVRAA)

[Note: This form can be used only AFTER a job offer has been accepted or for any current employees. This form is only collecting veteran status for VETS-4212 Reporting and VEVRAA affirmative action plans. Prior to accepting a job offer, an applicant cannot be asked to self-identify with a specific category(s) of protected veteran. Employers can only ask an applicant to specify if he or she IS or IS NOT a protected veteran.]

As a government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act (VEVRAA) of 1974, [Company Name] is required to submit a report to the U.S. Department of Labor each year identifying the number of protected veterans who were newly hired, as well as the number of protected veterans who were employed. If you believe you belong to any of the categories of protected veterans listed below, please indicate so by checking the appropriate box.

Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are consistent with the VEVRAA, as amended. 

Print Name: ______________________________________

Print Job Title: ____________________________________

I belong to the following classifications of protected veterans (choose all that apply):

  • Disabled Veteran

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.  
  • Recently Separated Veteran

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.  

  • Active Wartime or Campaign Badge Veteran

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. 

  • Armed Forces Service Medal Veteran

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 U.S. military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.


  • I am a protected veteran, but I choose not to self-identify the classifications to which I belong. 

  • I am NOT a protected veteran. 

Signature: _____________________________________

Date: _________________________________________



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