forminator forms two veteran disclosure

ENROLLMENT FORM

Voluntary Protected Veteran Self-Identification Form

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to protected veterans. To help measure how well we are doing, we are asking you to tell us if you fall into one of the protected categories below. Completing this form is voluntary, but we hope that you will choose to fill it out. Any answer you give will be kept private and will not be used against you in any way.

Protected Veteran Status (or leave blank if the paragraph above serves as the label)Disabled Veteran: a veteran who is: (1) entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) was discharged or released from active duty because of a service-connected disability.Active Duty Wartime or Campaign Badge Veteran: a veteran who served in 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.Recently Separated Veteran: a veteran who served on active duty in the U.S. military, ground, naval or other air service, during the three-year period beginning on the date of such veteran's discharge or release from duty.Armed Forces Service Medal Veteran: a veteran who, while still serving on active duty on 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 (61 Fed. Reg. 1209).Not Applicable

To sign this document, please enter 'agree' and digitally sign:

Type 'agree' to confirm *

Certification and Electronic Signature *I certify that I am the person identified in this questionnaire and that all information and supporting documents I have submitted are true, accurate, complete, and not misleading as of the date signed. I have reviewed my responses and had the opportunity to correct them before signing.

I understand that Prisma International Corporation and its affiliated companies may rely on the information provided when evaluating my enrollment, qualifications, onboarding, eligibility for assignments, and contractor relationship. I understand that any material false statement, misrepresentation, or omission may result in disqualification, suspension or withdrawal of assignments, or termination of the contractor relationship, subject to applicable law and any governing agreement.

By checking the acknowledgment box, entering or signing my name, and submitting this questionnaire, I confirm my intent to sign electronically. I consent to the use and retention of this electronic record and agree that my electronic signature has the same force and effect as my handwritten signature.I have read, understand, and agree to the Certification and Electronic Signature statement above.

E-Signature *

Your Name *

Date