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RESOURCES
FAQ
MY ACCOUNT #
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
Large Employer, Gold Medallion
Instructions
B. Veteran Employee Criteria
C. Integration Assistance Criteria
Employer Identity
Employer Address
Employer Size
Please note that this form includes accompanying instructions for the Large Employer Gold Award that explain
how to fill out this form. These instructions include important information, such as definitions and rules, for
determining whether an employer has met the medallion criteria. You must read the instructions for the Large
Employer Gold Award prior to completing and submitting the application.
1
OMB Burden Statement: Persons are not required to respond to this collection of information unless it
displays a currently valid OMB number. Obligation to respond is required to obtain or retain benefits under the
Honoring Investments in Recruiting and Employing American Military Veterans Act. The 10.75 hour public
reporting burden for this collection of information, which is to apply for an award showcasing excellence in
hiring and retaining veterans, includes time to review instructions, search existing data sources, gather and
maintain the data needed, and complete and review the collection of information. Send comments regarding
this burden estimate, or any other aspect of this collection, including suggestions for reducing burden, to the
U.S. Department of Labor, Veterans' Employment and Training Service, Room S-1212, 200 Constitution
Avenue, NW, Washington, DC 20210.
D. Labor Law Violations
E. Review and Attestation
F. Pay Application Fee
If you need assistance please see our FAQ page.
Questions?
If you need to find answers
and general information
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Medallion Application, please
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Instructions
B. Veteran Employee Criteria
Employer Address
Employer Identity
Employer Size
Item 1 Employer Name (*Required)
C. Integration Assistance Criteria
5
Enter the exact employer name assigned the Employer Identification Number (EIN) listed in Item 2.
D. Labor Law Violations
Item 2 Enter the employer EIN
$6
E. Review and Attestation
45
Do not enter your SSN on this line.
F. Pay Application Fee
Item 3 Data Universal Number System (DUNS) Number
7
Enter the DUNS number if one exists.
Questions?
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
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Item 4 Employer Doing Business As (DBA) Name
If the employer utilizes a DBA, enter it here.
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United States
Department of Labor
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Instructions
B. Veteran Employee Criteria
Employer Identity
Employer Address
Employer Size
Item 5 Employer Street Address (*Required)
C. Integration Assistance Criteria
8
Enter the official address (number, street, and room or suite number, as applicable, of the
employer's principal office or place of business) for the employer listed in Item 1.
D. Labor Law Violations
Item 6 Employer City or Town (*Required)
E. Review and Attestation
9
Enter the city or town.
F. Pay Application Fee
Item 7 Employer State or Province
(*Required)
Questions?
SELECT ONE
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
Item 8 ZIP Code or Postal Code
(*Required)
$ 10
12
Enter the State or province.
11
Enter the ZIP code or postal code.
46
Item 9 Country (*Required)
UNITED STATES
13
Select the Country.
CONTACT US
14
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United States
Department of Labor
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Instructions
B. Veteran Employee Criteria
C. Integration Assistance Criteria
Employer Identity
Employer Address
Employer Size
Item 10 Employer Size: Did you have 500 or more employees as of December 31 of 2018 (the
year prior to the year in which you are submitting the application)? If the answer to this
question is “No" you are submitting the wrong form.
$
15
For the purposes of this item, "employees" includes both veteran and non-veteran employees,
as well as permanent full-time and permanent part-time employees. "Employees" does not
include temporary workers. For additional information about the definitions of employee,
temporary worker, and veteran, please see the instructions. (*Required)
D. Labor Law Violations
E. Review and Attestation
Yes 16 If No, return to your Dashboard, delete this application and begin a new one for the correct size
F. Pay Application Fee
Item 11 Medallion Level: Are you applying for the gold level? (*Required)
Yes 17 If No, return to your Dashboard, delete this application and begin a new one for the correct level
Questions?
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
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SAVE AND CONTINUE
CONTACT US
United States
Department of Labor
Engage
Share
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Hiring
B. Veteran Employee Criteria
C. Integration Assistance Criteria
Retention
$ 18
Please refer to the definitions of employee, temporary worker, and veteran in the
instructions when completing Section B.
HIRING: 7% Requirement
D. Labor Law Violations
Item 12 Enter the number of veterans hired in 2018 (the preceding
calendar year (CY)). (*Required)
E. Review and Attestation
F. Pay Application Fee
Questions?
19
Item 13 Enter the total number of employees (including veterans) hired in 2018 (the
preceding CY). (*Required)
20
Item 14 The veteran hiring percentage in 2018 (the preceding CY) was… (*Required)
21
0.0%
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Item 12 divided by Item 13. Item 14 must be not less than 7% for the applicant to
qualify for the Large Employer Gold Award.
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
BACK
SAVE AND CONTINUE
CONTACT US
United States
Department of Labor
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Hiring
B. Veteran Employee Criteria
C. Integration Assistance Criteria
Retention
RETENTION: 75% Requirement
Item 15 Enter the number of veterans hired in 2017 (the CY preceding the
preceding CY). (*Required)
22
Item 16 Enter the number of veterans hired in 2017 (the CY preceding the
preceding CY) who remained with the employer for at least 12 months. (*Required)
23
D. Labor Law Violations
E. Review and Attestation
F. Pay Application Fee
Item 17 The percentage of veterans retained for 12 months was... (*Required)
Item 16 divided by Item 15. Item 17 must be not less than 75% for the applicant to qualify
for the Large Employer Gold Award.
Questions?
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
BACK
0.0%
24
SAVE AND CONTINUE
CONTACT US
United States
Department of Labor
Engage
Share
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
$
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Employee Veteran Organization or Resource Group
B. Veteran Employee Criteria
C. Integration Assistance Criteria
Leadership Program
Community
# 25
Item 18 Briefly describe your employee veteran organization or resource group. Your employee
veteran organization or resource group must assist new veteran employees with integration,
including coaching and mentoring. See Item 18 in the instructions for additional guidance about
employee veteran organization or resource group criterion requirements (*Required)
D. Labor Law Violations
26
E. Review and Attestation
F. Pay Application Fee
(1,000 character limit)
Questions?
BACK
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
SAVE AND CONTINUE
CONTACT US
United States
Department of Labor
Engage
Share
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
$
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Employee Veteran Organization or Resource Group
B. Veteran Employee Criteria
C. Integration Assistance Criteria
Leadership Program
Community
Item 19 Briefly describe the programs you have established to enhance the leadership skills of
veteran employees during their employment. See Item 19 in the instructions for additional guidance
about leadership program criterion requirements. (*Required)
# 27
28
D. Labor Law Violations
E. Review and Attestation
F. Pay Application Fee
(1,000 character limit)
Questions?
BACK
SAVE AND CONTINUE
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
CONTACT US
United States
Department of Labor
Engage
Share
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Employee Veteran Organization or Resource Group
B. Veteran Employee Criteria
C. Integration Assistance Criteria
Leadership Program
Community
Item 20 (OPTIONAL) Briefly describe any employer efforts to support the veteran and military
community that fall outside of the criteria but may serve as models of support for veterans and their
families.This may include efforts such as veteran/military spouse recruitment and employment.
This will not factor into whether an employer receives an award.
D. Labor Law Violations
E. Review and Attestation
F. Pay Application Fee
(1,000 character limit)
Questions?
BACK
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
SAVE AND CONTINUE
CONTACT US
United States
Department of Labor
Engage
Share
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
OMB No. (1293-0015)
Form expires: 1/31/21
Large Employer, Gold Medallion
Labor Law Violations
B. Veteran Employee Criteria
C. Integration Assistance Criteria
$
Item 21 As further explained in Item 21 of the instructions, the employer has not had an
adverse labor law decision, stipulated agreement, contract debarment, or contract termination
pursuant to USERRA or VEVRAA. By selecting the "I Agree" button below, you certify that the
above statement is true. (*Required)
35
I agree 36
D. Labor Law Violations
E. Review and Attestation
BACK
SAVE AND CONTINUE
F. Pay Application Fee
Questions?
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
CONTACT US
United States
Department of Labor
Engage
Share
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
Return to Dashboard
2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
Review and Attestation
B. Veteran Employee Criteria
Review
C. Integration Assistance Criteria
Please review the information below to ensure it is accurate.
A. Employer Information
D. Labor Law Violations
E. Review and Attestation
F. Pay Application Fee
Questions?
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
CONTACT US
Item 1
Employer Name
Item 2
Employer EIN
##-#######
Item 3
Data Universal Number System (DUNS) Number
###############
Item 4
Employer Doing Business As (DBA) Name
N/A
Item 5
Employer Street Address
Item 6
Employer City or Town
Item 7
Employer State or Province
or
Item 8
Employer ZIP Code or Postal Code
#####
Item 9
Country
Item 10 Employer Size
Yes - Large
Item 11 Medallion Level: Platinum
Yes - Gold
58
B. Veteran Employee Criteria
Item 12 Enter the number of veterans hired in 2018 (the
preceding calendar year (CY)).
########
Item 13 Enter the total number of employees (including
veterans) hired in 2018 (the preceding CY).
########
Item 14 The veteran hiring percentage in 2018 (the
preceding CY) was…
########
Item 15 Enter the number of veterans hired in 2017 (the
CY preceding the preceding CY).
####
Item 16 Enter the number of veterans hired in 2017 (the
CY preceding the preceding CY) who remained
with the employer for at least 12 months.
####
Item 17 The percentage of veterans retained for 12
months was…
####
C. Integration Assistance Criteria
Item 18 Briefly describe your employee veteran
organization or resource group. Your employee
veteran organization or resource group must
assist new veteran employees with integration,
including coaching and mentoring.
Lorem ipsum dolor sit amet, consectetur
adipiscing elit. Quisque ullamcorper
viverra aliquet.
Item 19 Briefly describe the programs you have
established to enhance the leadership skills of
veteran employees during their employment.
Lorem ipsum dolor sit amet, consectetur
adipiscing elit. Quisque ullamcorper
viverra aliquet.
Item 20 Briefly describe any employer efforts to support
the veteran and military community that fall
outside of the criteria but may serve as models
of support for veterans and their families.This
may include efforts such as veteran/military
spouse recruitment and employment.
Lorem ipsum dolor sit amet, consectetur
adipiscing elit. Quisque ullamcorper
viverra aliquet.
59
59
E. Labor Law Violations
Item 21 As further explained in Item 21 of the
instructions, the employer has not had an
adverse labor law decision, stipulated
agreement, contract debarment, or contract
termination pursuant to USERRA or VEVRAA.
By selecting the "I Agree" button below, you
certify that the above statement is true.
I agree
Attestation Information
For items 22-23, provide the information for the person attesting to Item 26
Item 22 First and Last Name (*Required)
37
Item 23 Title (*Required)
38
53
54 55
Select the relevant title for the person attesting to Item 26.
Item 24 Contact Email Address (*Required)
39
Item 25 Contact Phone Number (*Required)
40
Item 26 Attestation (*Required)
I declare under penalty of perjury under the laws of the United States of America that:
1. I am the Chief Executive Officer or the Chief Human Relations Officer of this employer submitting
this application (hereinafter “the Employer”), or an equivalent official (someone with equivalent
responsibilities and duties, such as the owner of a small firm) of the Employer;
2. The Employer has met all necessary award criteria;
3. I have read and reviewed this application and the information contained therein is true and
accurate; and
4. I understand that to knowingly furnish false information in the preparation of this form and any
supplement thereto or to aid, abet, or counsel another to do so is a violation of Federal law under 18
U.S.C. 1001.
Entering your name in Item 22 above and then clicking on the "I agree" button below constitutes your
signing the above attestation under penalty of perjury.
I agree
41
Item 27 Application Fee Payment (*Required)
The application fee is posted at https://www.hirevets.gov. By selecting the "I understand" button
below, you acknowledge understanding that your application will not be processed until the
application fee payment is received, and that your application will not be processed if the fee is
received after the end of the application period.
I understand
42
Disclaimer: Information submitted as part of this publication may be made available to the public. Applicants
should not include any proprietary or confidential business information or personally identifiable information
(PII) in this summary. In the event that an applicant submits proprietary or confidential business information or
PII, DOL is not liable for making this information public. The submission of the application constitutes a waiver
of the applicant’s objection to the posting of any proprietary or confidential business information contained in
the application. Additionally, the applicant is responsible for obtaining all authorizations from relevant parties
for publishing all PII contained within the application. In the event the application contains proprietary or
confidential business information or PII, the applicant is presumed to have obtained all necessary
authorizations to provide this information and may be liable for any improper release of this information.
BACK
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1-866-4-USA-DOL
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•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
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Pay Differential Program
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Tuition Assistance
Accessibility Statement
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Sections
#
NEWS
RESOURCES
OMB No. (1293-0015)
Form expires: 1/31/21
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2019 HIRE Vets Application
A. Employer Information
MY ACCOUNT "
FAQ
Large Employer, Gold Medallion
B. Veteran Employee Criteria
$ Your application has been submitted.
C. Integration Assistance Criteria
Pay Application Fee
The application fee for your application must be paid before it can be processed by VETS.
D. Labor Law Violations
% Note: Payment must be submitted by April 30th and completed no later than May 31st
E. Review and Attestation
Identify Payment Maker
F. Pay Application Fee
Identify whether you or another individual from your organization will be making the application fee payment
for your organization’s HIRE Vets Medallion Program Award Application.
I am making the payment
Questions?
If you need to find answers
and general information
quickly about the HIRE Vets
Medallion Application, please
review the FAQ Page.
Someone else is making the payment
CONTACT US
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
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Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
NEWS
RESOURCES
FAQ
MY ACCOUNT "
Make Payment
Pay Application Fee on Pay.gov
Not paying on Pay.gov?
If someone else from your organization will be making the Application Fee
payment on Pay.gov, please provide them with the following link and
Application ID so that they can make the application fee payment:
Enter your Application ID
here on the Pay.gov form
Application ID: ##-####-##########
Payment URL: https://www.pay.gov/addurlhere
You can copy and paste your Application ID directly from this page to the
Payment Form in Pay.gov.
Note that it may take up to 1-3 business days for your payment to be reflected
on your HIRE Vets Medallion Application dashboard
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MAKEtoPAYMENT
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
NEWS
RESOURCES
FAQ
MY ACCOUNT "
Return to Dashboard
$
Make Payment
We use industry-standard encryption to protect the confidentiality of your personal information.
Your payment will be submitted through Pay.gov, a U.S. Government payment service.
86
Select Payment Method
xxxx-xxxx-xxxx-xxxx
XXXX
XX/XX/XX
Account Holder Name
#
Credit Card / Debit Card
#
Direct Debit / ACH Debit
65
66
Enter Payment Details
Payment Information
Application Fee
Payer Information
This information is about the individual making the payment
$495 USD
First Name (*Required)
Account Type (*Required)
Middle
71
Business Checking
67
Last Name (*Required)
Select the Account Type
72
Business Name (*Required)
68
85
Employer Name (*Required)
73
Account Number (*Required) #
77
Payer Email (*Required)
74
69
Routing Number (*Required) #
78
Payer Phone (*Required)
70
65
75
# Note: Payments may take 1-3 business days to process before your updated payment status is reflected on your
Hirevets.gov dashboard
I understand that I am authorizing a charge to the above account for this Application Fee, which covers
the cost of processing my application and is non-refundable.
United States
Department of Labor
76
MAKE
Submit
PAYMENT
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
$
NEWS
RESOURCES
FAQ
MY ACCOUNT "
Return to Dashboard
Make Payment
We use industry-standard encryption to protect the confidentiality of your personal information.
Your payment will be submitted through Pay.gov, a U.S. Government payment service.
86
Select Payment Method
xxxx-xxxx-xxxx-xxxx
XXXX
XX/XX/XX
Account Holder Name
#
Credit Card / Debit Card
#
Direct Debit / ACH Debit
65
66
Enter Payment Details
Payment Information
Payer Information
Application Fee
First Name (*Required)
$495 USD
71
Card Type (*Required)
Business
Middle
79
Personal
Last Name (*Required)
Account Holder Name (*Required)
72
83
80
Employer Name (*Required)
73
Account Number (*Required) #
69
Card Security Code (*Required) #
Payer Email (*Required)
74
81
82
Payer Phone (*Required)
Note: if your card does not have a security code, Contact Us
75
Card Expiration (*Required)
Month
Year
Select Month
Select Year
84
I understand that I am authorizing a charge to the above account for this Application Fee, which covers
the cost of processing my application and is non-refundable.
76
MAKE
Submit
PAYMENT
United States
Department of Labor
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
$
NEWS
RESOURCES
FAQ
MY ACCOUNT "
Return to Dashboard
Payment Status
% Print
# Your Direct Debit / ACH Payment was received and will soon be processed
Note: Payments may take 1-3 business days to process before your updated payment status is reflected on your Hirevets.gov dashboard
Payment Summary
Payment Information
Confirmation Number
paygov_tracking_id
& COPY
Payer Information
Payer Name:
Employer Name:
Payer Email:
Payer Phone:
Joe Example
Sample, Inc
[email protected]
123-456-7890
Payment Method
Direct Debit / ACH Debit
Payment Details
Account Type:
Business Name:
Account Number:
Payment Amount:
Business Checking
Sample, Inc
XXXXX1234
$495 US
Return
MAKEtoPAYMENT
Dashboard
United States
Department of Labor
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FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
United States Department of Labor
! Contact
ABOUT
$
NEWS
RESOURCES
FAQ
MY ACCOUNT "
Return to Dashboard
Payment Status
% Print
# Your Plastic Card Payment was successful
Payment Summary
Payment Information
Confirmation Number
paygov_tracking_id
& COPY
Payer Information
Payer Name:
Employer Name:
Payer Email:
Payer Phone:
Joe Example
Sample, Inc
[email protected]
123-456-7890
Payment Method
Plastic Card
Payment Details
Name:
Business Name:
Account Number:
Payment Amount:
Joe Example
Sample, Inc
XXXXX1234
$495 US
Return
MAKEtoPAYMENT
Dashboard
United States
Department of Labor
Engage
Share
FEDERAL GOVERNMENT
LABOR DEPARTMENT
ABOUT THE SITE
200 Constitution Ave. NW
White House
Español
Freedom of Information Act
Washington DC 20210
Affordable Care Act
Office of Inspector General
Privacy & Security Statement
1-866-4-USA-DOL
1-866-487-2365
•
7% of new hires are veterans AND 75% of
veterans
were retained
Disaster
Recovery
Assistance
•
The employer must have BOTH a Veteran
Organization or Resources Group AND A
USA.gov
Leadership Program
TTY
Plain Writing Act
www.dol.gov
Recovery Act
No Fear Act
U.S. Office of Special Counsel
•
10% of new hires are veterans
• DOL
85%Newsletter
of veterans were retained
Subscribe to the
Disclaimers
•
The employer must have all of the following Veteran
Integration Assistance Programs: Important Web Site Notices
Read The DOL Newsletter
⁃
Veteran Organization or Resource Group
⁃
Leadership Program
Emergency Accountability Status Link
Plug-ins Used by DOL
⁃
Human Resource Veterans Initiative
⁃
Pay Differential Program
A to Z Index
RSS Feeds from DOL
⁃
Tuition Assistance
Accessibility Statement
| File Type | application/pdf |
| File Modified | 2018-11-27 |
| File Created | 2018-11-27 |