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Federal Contractor Veterans' Employment Report Vets-100

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APPENDIX A TO PART 61-250 – FEDERAL CONTRACTOR VETERANS' EMPLOYMENT

REPORT VETS-100

FEDERAL CONTRACTOR VETERANS’ EMPLOYMENT REPORT VETS-100

(For covered contracts entered into before December 1, 2003.)

OMB NO: 1293-0005

RETURN COMPLETED REPORT TO:

VETS-100 Submission

VETERANS’ EMPLOYMENT AND TRAINING SERVICE (VETS)

Expires:

09/30/2014

Service Center

In care of: Department of Labor National Contact Center (DOL-NCC)

Suite 200

Persons are not required to respond to this collection of information unless

14120 Newbrook Drive

it displays a valid OMB number

Chantilly, VA 20151

TYPE OF FORM (Check only one)

TYPE OF REPORTING

ORGANIZATION (Check one or both,

as applicable)

Single Establishment

Multiple Establishment-Headquarters

Prime Contractor

Multiple Establishment-Hiring Location

ATTN: Human Resource/EEO Department

Subcontractor

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

M M D D 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:

EMPLOYER ID

(IRS TAX No.)

NAICS:

DUNS:

INFORMATION ON EMPLOYEES

REPORT ALL PERMANENT FULL-TIME OR PART-TIME EMPLOYEES AND NEW HIRES WHO ARE TARGETED VETERANS, DATA ON NUMBER OF EMPLOYEES ARE TO BE ENTERED IN

COLUMNS L, M, N, AND O, LINES 1-9, DATA ON NEW HIRES ARE TO BE ENTERED IN COLUMNS P, Q, R, S, AND T. INSTRUCTIONS ARE FURTHER DETAILED ON THE REVERSE OF

THIS FORM.

NUMBER OF EMPLOYEES

NEW HIRES (PREVIOUS 12 MONTHS)

JOB

SPECIAL

OTHER

RECENTLY

OTHER

DISABLED

VIETNAM ERA

PROTECTED

SEPARATED