Carol Stream Fire Protection District Preference Point Claim Form And Affidavit (Page 2 of 3) in pdf

Carol Stream Fire Protection District Preference Point Claim Form And Affidavit Page 2

CAROL STREAM FIRE PROTECTION DISTRICT

PREFERENCE POINT CLAIM FORM AND AFFIDAVIT

If you wish to claim preference points for the final eligibility list for hire with the Carol Stream Fire Protection

District, please complete the following form and submit it with any required attachments within ten (10) days after the

posting of the preliminary eligibility list. Failure to submit the request within ten (10) days shall be deemed a waiver

of the points.

A. Veteran’s Preference Points (70 ILCS 705/16.08a and 16.06b(h)(1))

Preference Points Available:

Please state the following information regarding your military service and attach form DD-214 (long form) and proof

of honorable discharge:

Branch of Service:

Unit:

Rank:

Date of Service (month/date/year):

Date of Honorable Discharge:

B. Educational Preference Points (70 ILCS 705/16.06b(h)(3))

Preference Points Available:

maximum of 3 points

Please state the following information regarding your educational background and attach a certified transcript as

proof of the attainment of a degree:

College Attended:

Dates of Attendance (month/date/year):

Degree Awarded:

College Attended (if applicable):

Dates of Attendance (month/date/year):

Degree Awarded:

D. Additional Preference Points (70 ILCS 705/16.06b(h)(7))

Preference Points Available:

maximum of 2 points

Please state the relevant dates of successful contract service as a firefighter/paramedic with the CSFPD

Carol Stream Fire Protection District Contract Firefighter/Paramedic

Date of Service (month/date/year):

Carol Stream Fire Protection District Preference Point Claim Form And Affidavit Page 2