Form VETS-4212 FEDERAL CONTRACTOR VETERANS’ EMPLOYMENT REPORT VETS-4212

FEDERAL CONTRACTOR VETERANS’ EMPLOYMENT REPORT VETS-4212

OMB NO: 1293-0005 Expires: xxxxx	RETURN COMPLETED REPORT TO: VETS-4212 Submission VETERANS’ EMPLOYMENT AND TRAINING SERVICE (VETS) Service Center In care of: Department of Labor National Contact Center (DOL-NCC) 14120 Newbrook Drive Chantilly, VA 20194
Persons are not required to respond to this collection of information unless it displays a valid OMB number. It is mandatory for a covered Federal contractor respond to this information collection. See 38 U.S.C. § 4212(d) and “Who Must File” section of instructions.
ATTN: Human Resource/EEO Department	TYPE OF REPORTING ORGANIZATION (Check one or both, as applicable) Prime Contractor Subcontractor	TYPE OF FORM (Check only one) Single Establishment Multiple Establishment-Headquarters Multiple Establishment-Hiring Location Multiple Establishment-State Consolidated (specify number of locations) (MSC)

COMPANY IDENTIFICATION INFORMATION (Omit items preprinted above-ADD Company Contact Information Below)

COMPANY No:	TWELVE MONTH PERIOD ENDING							2	0	1	4
				M	M	D	D	Y	Y	Y	Y
NAME OF PARENT COMPANY:	ADDRESS (NUMBER AND STREET):
CITY:	COUNTY:		STATE:			ZIP CODE:
NAME OF COMPANY CONTACT: TEL	TELEPHONE FOR CONTACT:	EMAIL:
NAME OF HIRING LOCATION:	ADDRESS (NUMBER AND STREET):
CITY:	COUNTY:		STATE:			ZIP CODE:

NAICS:

DUNS:

_

_

EMPLOYER ID (IRS TAX No.)

_

INFORMATION ON EMPLOYEES

REPORT ALL PERMANENT FULL-TIME OR PART-TIME EMPLOYEES AND NEW HIRES WHO ARE PROTECTED VETERANS, AS DEFINED ON REVERSE. DATA ON NUMBER OF EMPLOYEES ARE TO BE ENTERED IN COLUMN A AND B, LINES 1-9. DATA FOR NEW HIRES ARE ENTERED AND IN COLUMNS C AND D. LINE 11 IS TOTAL OF EACH COLUMN. ENTER THE MAXIMUM AND MINIMUM NUMBER OF EMPLOYEES. INSTRUCTIONS ARE FOUND ON THE REVERSE OF THIS FORM.
JOB CATEGORIES	NUMBER OF EMPLOYEES					NEW HIRES (PREVIOUS 12 MONTHS)
	PROTECTED VETERANS (A)			TOTAL EMPLOYEES (B)		PROTECTED VETERANS (C)				TOTAL NEW HIRES (D)
Executive/Senior Level Officials and Manage 1
First/Mid Level Officials and Managers 2
PROFESSIONALS 3
TECHNICIANS 4
SALES WORKERS 5
ADMINISTRATIVE SUPPORT WORKERS 6
CRAFT WORKERS 7
OPERATIVES 8
LABORERS/HELPERS 9
SERVICE WORKERS 10
TOTAL EMPLOYEES 11

Report the total maximum and minimum number of permanent employees during the period covered by this report.

Maximum Number	Minimum Number

Form VETS-4212 MM/YYYY