Fill - Free fillable CSU Fresno VETERAN SELF-IDENTIFICATION FORM 2008-12 PDF form

TheCaliforniaStateUniversityHR2008‐12

ATTACHMENTA

California State University, Fresno



TheCaliforniaStateUniversity   08/2008



VETERAN SELF-IDENTIFICATION FORM

(for use by new hires and current employees only)

TheCaliforniaStateUniversity(CSU)isafederalcontractorsubjecttotheVietnamEraVeteransReadjustmentAssistanceActof

1974(VEVRAA),asamended,whichrequiresthatfederalcontractorstakeaffirmativeactiontoemployandadvancein

employmentqualifiedindividualswithoutdiscriminatioinbasedonacoveredveteranstatus.Tofulfillstatisticalreportingand

affirmativeactionmonitoringrequirements,theCSUinvitesyoutovoluntarilyidentifyyourveteranstatus

byansweringthe

questionsbelow.Submissionofthisinformationisvoluntaryandnoadverseconsequenceswillresultfromeitherprovidingthis

informationordecliningtoprovideit.Informationyousubmitwillbekeptconfidentialasrequiredunderapplicablefederaland

statelaw.Shouldyoudecidenottoself‐identifyatthistime,youmaydosoatanytimeinthefuture.Note:Ifyouaredisabled,

andneedaccommodationtoperformthejobproperlyandsafely,pleasecontactyourHumanResourcesorFacultyAffairsOffice

tobeginaninteractivediscussiontoidentifyandprovideyouareasonableaccommodation.

Pleasecheckal

lboxesthatapplytoyou:

Idonotwanttoidentifymyveteranstatus



Notaveteran



DisabledVeteran

Either(1)aveteranoftheU.S.military,ground,navalorairservicewhoisentitledtocompensation(orwhobutforthe

receiptofmilitaryretiredpaywouldbeentitledtocompensation)underlawsadministratedbytheSecretaryofVeterans

Affairs,or(2)apersonwhowasdischargedorreleasedfromactivedutybecauseofaservice‐connecteddisability.



RecentlySeparatedVeteran

Anyveteranduringthethree‐yearperiodbeginningonthedateofsuchveteran’sdischargeorreleasefromactivedutyin

theU.S.military,ground,navalorairservice. DischargeDate(mm/dd/yyyy):______/______/______



ArmedForcesServiceMedalVeteran

Anyveteranwho,whileservingonactivedutyintheU.S.military,ground,navalorairservice,participatedinaUnited

StatesmilitaryoperationforwhichanArmedForcesservicemedalwasawardedpursuanttoExecutiveOrder12985.

(For

thecurrentlistofmilitaryoperationsforwhichanArmedForcesservicemedalwasawarded,seetheattachment.Visit

http://www.opm.gov/Veterans/h

tml/vgmedal2.htmforupdates.)



OtherProtectedVeteran

AveteranwhoservedonactivedutyintheU.S.military,ground,navalorairserviceduringawarorinacampaignor

expeditionforwhichacampaignbadgehasbeenauthorizedunderthelawsadministeredbytheDepartmentofDefense.

(Forthecurrentlistofcampaignsandexpeditionsforwhichacampaignbadgewasauthorized,seetheattachment.Visit

http://www.opm.gov/Veterans/h

tml/vgmedal2.htmforupdates.)



___________________________________ ___________________________________





EmployeeName

  Department



___________________________________ _________________

EmployeeSignature

  Date



ItisthepolicyofCaliforniaStateUniversitytoprovideequalemploymentopportunitywithoutregardtorace,color,religion,

nationalorigin,ancestry,age,physicaldisability,mentaldisability,medicalcondition,veteranstatus,maritalstatus,

pregnancy,sex,sexualorientation,orgenderidentity.TheCSUadministersallpersonnelactionswithoutregardtoany

characteristicprotectedbylawandbasesallemploymentdecisionsonvalidjobrequirements.

See41CFR60‐300and41CFR61‐300.

61FR1209.

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