County Of San Luis Obispo Veterans Preference Form printable pdf download

APPLICA TION FOR VETERANS PREFERENCE

COUNTY OF SAN LUIS OBISPO, CALIFORNIA

INSTRUCTIONS:

Present this form to the Veterans Service Office, 801 Grand Ave., San Luis Obispo, California, WITH required evidence as follows:

VETERANS: Documentary evidence of honorable wartime service in the Armed Forces. (DD214)

DISABLED VETERANS:

Documentary evidence of honorable wartime service in the Armed Forces (DD214); and Veterans

Administration letter dated within the last year verifying service connected disabled status. V.A. letter must be submitted with each

employment application.

SPOUSE OF DISABLED VETERAN: Documentary evidence of veteran’s honorable wartime service in the Armed Forces (DD214);

evidence of permanent and total disability of veteran; marriage certificate.

WIDOWS: Documentary evidence of husband’s honorable wartime service in the Armed Forces (DD214); marriage certificate;

evidence of death of veteran.

PLEASE PRINT OR TYPE:

Social Security No. __________________________

_________________________________________

__________________

(Last name)

(First Name)

(Middle Initial)

Name used in service ___________________________________________________________________________________________________

_________________________________________

__________________

(Mailing address, Street or P.O Box)

(City)

(State)

_________________________________________

__________________

(Date of Birth)

(Place of Birth)

(Phone Number)

SERVICE INFORMATION: (If more than three periods of service, continue on reverse side.)

ENTERED ACTIVE DUTY

SERIAL NO.

SEPARATED FROM SERVICE

CHARACTER OF

SERVICE

SEPARATION

BRANCH

DATE

PLACE

DATE

PLACE

SIGNATURE OF APPLICANT:

I HEREBY CERTIFY that the statements on this application are true. I agree and understand that any misrepresentation of material facts herein

may cause forfeiture of all right to any employment in service of the County of San Luis Obispo.

___________________________________

_________________________________________________________

(Date of Application)

(Signature of Applicant)

DO NOT WRITE BELOW THIS LINE

CERTIFICATION:

I HEREBY CERTIFY that I have examined the documentary evidence of applicant and that status of eligibility for Veterans Preference is as

follows:

(Date)

APROVED: _______________________________ _________________________________________ ________________________________

PENDING: _______________________________

(Signature)

(Title)

REJECTED: ______________________________

REMARKS: ___________________________________________________________________________________________________________

This application will be kept on file in the office of the Veterans Service Officer. Eligibility for Veterans Preference will be verified by the Civil

Service Commission following examination for County Employment.

P:\Administration\FORMS\APPLICATION FOR VETERANS PREFERENCE.doc

County Of San Luis Obispo Veterans Preference Form

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