Veterans' Preference In Employment - Eligibility Form printable pdf download

VETERANS’ PREFERENCE IN EMPLOYMENT – ELIGIBILITY FORM

NAME:______________________________________

POSITION APPLYING FOR: _____________________________________

MILITARY SERVICE INFORMATION

Branch of Service ________________________________________________ Date of Entry____________________________

Date of Discharge ________________________ Type of Discharge _______________________________________________

CHECK THE CATEGORY BELOW WHICH APPLIES TO YOU AND SUBMIT THE REQUIRED DOCUMENTATION

PROPER DOCUMENTATION MUST BE PROVIDED: DD Form 214, Certificate of Discharge or Separation from Active Duty, or

other official documents (to include military discharge papers, or equivalent certification from the DVA listing military status, dates of

service, and discharge type) issued by the branch of service are required as verification of eligibility for veterans’ preference.

Additional documentation is required for certain categories listed below.

(15 Points) A veteran with a service-connected disability who is eligible for or receiving compensation,

disability retirement, or pension under public laws administered by the U.S. Department of

Veterans Affairs and the Department of Defense.

• Disabled veterans shall also furnish from the Department of Defense, the Department of Veterans’ Affairs, or the Division

of Veterans’ Benefits and Assistance, a document certifying that the veteran has a service-connected disability.

(10 Points) The Spouse

___ of a veteran who cannot qualify for employment because of total and permanent service-connected disability.

___ of a veteran missing in action, captured, or forcibly detained by a foreign power.

• Spouses of persons eligible to claim preference shall furnish certification from the VA that the veteran has a service-

connected disability.

• Spouses of disabled veterans shall also furnish either a certification from the Department of Defense or the VA that the

veteran is totally and permanently disabled or an identification card issued by the Division; spouses of disabled veterans

shall also furnish evidence of marriage to the veteran and a statement that the spouse is still married to the veteran;

spouses of disabled veterans shall also furnish proof that the disabled veteran cannot qualify for employment because of

the service-connected disability.

Spouses of persons on active duty shall furnish a document from the Department of Defense or the VA certifying that the

•

person on active duty is listed as missing in action, captured in line of duty, or forcibly detained or interned in line of duty by

a foreign government or power; spouses of persons on active duty shall also furnish evidence of marriage and a statement

that the spouse is married to the person at this time.

(10 Points) A veteran who has received an honorable discharge and who has served at least one day during a

wartime period; also a veteran who has been awarded a campaign or expeditionary medal. Active

duty for training may not be allowed for eligibility under this paragraph.

Provide a copy of DD-214 form or equivalent from the DD or DVA showing military status, dates of service and discharge

•

type; and campaign or expeditionary medal, if applicable.

(10 Points) An unremarried widow or widower of a veteran who died of a service-connected disability.

• The unmarried widow or widower of a deceased veteran who died of a service-connected disability shall furnish a

document from the Department of Defense or the VA certifying the service-connected death of the veteran, and shall also

furnish evidence of marriage and a statement the spouse is not remarried.

(10 Points) The mother, father, legal guardian, or unremarried widow or widower of a member of the United

States Armed Forces who died in the line of duty under combat-related conditions, as verified by

the DD.

If the applicant is the mother, father or legal guardian, provide veteran's DD-214 Form or equivalent from the DD or DVA

•

certifying the service-connected death of the veteran under combat-related conditions, the veteran's death certificate,

and court document(s) establishing legal authority of guardian.

If the applicant is the unremarried widow or widower, provide statement that applicant is unremarried, certificate of

•

marriage to the veteran, veteran's DD-214 Form or equivalent from the DD or DVA certifying the service-connected death

of the veteran under combat-related conditions, and veteran's death certificate.

Page 1 of 3

Rev. 11.2014

Veterans' Preference In Employment - Eligibility Form

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