The California State University 3/29/2012
The California State University HR 2088-12
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 discrimination 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
1
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 all boxes that apply to you. (A minimum of one box must be checked.)
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.
2
(For the current
list of military operations for which an Armed Forces service medal was awarded, see the attachment. Visit
http://www.opm.gov/staffingportal/vgmedal2.asp 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/staffingportal/vgmedal2.asp for updates.)
U.S. Veteran, but not in any capacity listed above
I do not want to identify my veteran status.
___________________________________ ___________________________________________
Employee Name (Please PRINT) 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.
1
See 41 CFR 60-300 and 41 CFR 61-300
2
61 FR 1209
VETERAN SELF-IDENTIFICATION FORM
(for use by new hires and current employees only)
