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.
Disabled veteranRecently separated veteranActive wartime veteranArmed forces service medal veteranOther protected veteranI refused to identifyOther
Full Name
First NameLast Name
Position applying for
MaleFemale
Age
Date of Birth
MonthDayYear
Date
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
Date
Should be Empty: