Veterans Self Identify Form

Veterans Self Identify Form
This form is used to identify veterans in your company especially government contractors. It is important that the Department of Labor should now who are these protected veterans working under your organization. In this way, they can receive special benefits or qualify for certain programs.
Please take note that this submission is voluntary. If you wish not to be identified, then you have the right to refuse to complete this document.
This document is for:
(1) disabled veterans;
(2) recently separated veterans;
(3) active duty wartime or campaign badge veterans; and
(4) Armed Forces service medal veterans.
The data submitted from this form will be considered strictly confidential.
Please select what qualification of veteran you belongs to:
Other
Full Name
First NameLast Name
Position applying for
Gender
Age
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Ethnicity/Race
Number of Years in the Military
Again, filling up this form is voluntary. Also, your information will be strictly confidential.
Signature
Clear
Date Signed
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: