Form VETS-4212 Federal Contractor Veterans' Employment Report

FEDERAL CONTRACTOR VETERANS’ EMPLOYMENT REPORT VETS-4212

OMB NO: 1293-0005

Expires: xxxxx

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.

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

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	x	x
				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:	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 THE TOTAL NUMBER OF EMPLOYEES AND NEW HIRES WHO ARE PROTECTED VETERANS, AS DEFINED IN THE INSTRUCTIONS. DATA ON NUMBER OF EMPLOYEES ARE TO BE ENTERED IN COLUMN A AND B, LINES 1.1 THROUGH 9. DATA FOR NEW HIRES ARE ENTERED IN COLUMNS C AND D. LINE 10 IS TOTAL OF EACH COLUMN. ENTRIES IN COLUMNS C AND D, LINES 1.1 THROUGH 9 (GRAY SHADED AREAS) ARE OPTIONAL. ENTER THE MAXIMUM AND MINIMUM NUMBER OF EMPLOYEES.
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 MANAGERS 1.1
FIRST/MID LEVEL OFFICIALS AND MANAGERS 1.2
PROFESSIONALS 2
TECHNICIANS 3
SALES WORKERS 4
ADMINISTRATIVE SUPPORT WORKERS 5
CRAFT WORKERS 6
OPERATIVES 7
LABORERS/HELPERS 8
SERVICE WORKERS 9
TOTAL EMPLOYEES 10

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