Form

FEDERAL CONTRACTOR VETERANS’ EMPLOYMENT REPORT VETS-4212

RETURN COMPLETED REPORT TO:

VETS-4212 Submission
Veterans’ Employment and Training Service Center
Department of Labor National Contact Center (DOL-NCC)
3110 Fairview Park Drive, Suite 800
Falls Church, VA 22042

OMB NO: 1293-0005

Expires: 06/30/2027
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.

TYPE OF REPORTING ORGANIZATION

(Check one or both, as applicable)
Prime Contractor
Subcontractor

ATTN: Human Resource/EEO Department

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

M M

NAME OF PARENT COMPANY:

COUNTY:

NAME OF COMPANY CONTACT:

Y

Y

Y

Y

ZIP CODE:

STATE:

TELEPHONE FOR CONTACT:

NAME OF HIRING LOCATION:

EMAIL:

ADDRESS (NUMBER AND STREET):

CITY:

DUNS:

D

ADDRESS (NUMBER AND STREET):

CITY:

NAICS:

D

COUNTY:

_

EMPLOYER ID

(IRS TAX No.)

_

STATE:

ZIP CODE:

_

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.

NUMBER OF EMPLOYEES

PROTECTED VETERANS

TOTAL EMPLOYEES

(A)
(B)

JOB

CATEGORIES

NEW HIRES (PREVIOUS 12 MONTHS)

PROTECTED VETERANS

TOTAL NEW HIRES

(C)
(D)

EXECUTIVE/SENIOR LEVEL

OFFICIALS AND MANAGERS

1.1

FIRST/MID LEVEL

OFFICIALS AND

MANAGERS

1.2

PROFESSIONALS

TECHNICIANS

SALES WORKERS

ADMINISTRATIVE

SUPPORT WORKERS

CRAFT WORKERS

OPERATIVES

LABORERS/HELPERS

SERVICE WORKERS

TOTAL EMPLOYEES

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

Minimum Number

Form VETS-4212 11/2014

Federal Contractor Veterans’ Employment Report (VETS-4212) WHO MUST FILE: This VETS-4212 Report is to be completed by all nonexempt Federal contractors and subcontractors with a contract or subcontract in the amount of $150,000 or more with any department or