Veterans Preference Form printable pdf download

Veteran’s Preference Form

[CONFIDENTIAL PAGE]

Under Oregon law, veterans who meet minimum qualifications for a position may be eligible for employment

preference. Please read the following checklist carefully, and check the box for each item that applies to you. If

you need further explanation or have special circumstances, please call Administrative Assistant Tamara Nunez

at 541‐831‐2701.

IN ORDER TO BE ELIGIBLE TO RECEIVE VETERAN’S PREFERENCE, THIS COMPLETED FORM AND THE REQUIRED

SUPPORTING DOCUMENTATION MUST BE SUBMITTED WITH YOUR APPLICATION. PREFERENCE WILL NOT BE

AWARDED WITHOUT THE APPROPRIATE DOCUMENTATION.

A. QUALIFIED VETERAN QUESTIONS: You may claim veteran's preference if you check at least one box below

and provide proof of eligibility by submitting a copy of your form DD‐214 or DD‐215 that includes your discharge

status.

I served on active duty with the Armed Forces of the United States:

For a period of more than 90 consecutive days beginning on or before January 31, 1955 and was

discharged or released under honorable conditions, or

For a period of more than 178 consecutive days beginning after January 31, 1955 and was discharged or

released from active duty under honorable conditions, or

For 178 days or less and was discharged or released from active duty under honorable conditions

because of a service‐connected disability, or

For 178 days or less and was discharged or released from active duty under honorable conditions and

have a disability rating from the United States Department of Veterans Affairs, or

For at least one day in a combat zone and was discharged or released from active duty under honorable

conditions, or

I received a combat or campaign ribbon or an expeditionary medal for service in the Armed Forces of

the United States and was discharged or released from activity duty under honorable conditions; or

I am receiving a nonservice‐connected pension from the United States Department of Veterans Affairs.

Please see the next page for applicable definitions

B. QUALIFIED DISABLED VETERAN QUESTIONS: You may claim additional employment preference if you can

check at least one box below and provide proof of eligibility by submitting both of the documents listed below:

A copy of your DD‐214 or DD‐215, Certificate of Release or Discharge, Copy 4, and;

A public employment veteran’s disability preference letter from the United States Department of

Veterans' Affairs (unless the information is included in the DD Form 214/215). To order the letter, call 1‐

800‐827‐1000 and request a public employment preference letter.

I have a disability rating through the United States Department of Veterans Affairs; or

I was discharged or released from active duty for a disability incurred or aggravated in the line of duty;

I was awarded the Purple Heart for wounds received in combat.

I hereby claim veteran's preference points and certify that the above information is true and correct. I

understand that any false statements may be cause for my disqualification or dismissal, regardless of when

discovered.

___________________________________________________

_______________________________

Print Name

Service Number

___________________________________________________

_______________________________

Signature of Applicant

Date

Position Applied For: _______________________________________________________________________

MC/SM 7/2014

Veterans Preference Form

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