Application For Employment - Clackamas County Vector Control District (Page 6 of 7) in pdf

Veteran’s Preference Form

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 the District Manager at (503) 655-8394.

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

DOCUMENTATION MUST BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT. 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 non service-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:

1. A copy of your DD-214 or DD-215, Certificate of Release or Discharge, Copy 4, and

2. 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; or

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 _____________________________________________________________________________

Application For Employment - Clackamas County Vector Control District Page 6