City Of Niceville Application For Veteran'S Preference (Page 2 of 2) in pdf

APPLICATION FOR VETERAN’S PREFERENCE

Applicants wishing to assert Veteran’s Preference in employment should complete this questionnaire and attach a copy of their DD214

form or equivalent certification from the Veteran’s Administration to their completed employment application.

__________

I, _______________________________ wish to assert Veteran’s Preference in employment. I qualify under the

following category:

__________ 1)

Honorably discharged disabled Veteran who has a service connected compensable disability;

__________ 2)

The spouse of a totally disabled Veteran, who because of this disability cannot qualify for employment;

__________ 3)

The spouse of any person missing in action, captured in the line of duty or forcibly detained;

__________ 4)

A Veteran of any war who served on active duty during a “Wartime Era.” (See definition on Page 1)

__________ 5)

The unremarried widow or widower of a Veteran who died of a service connected disability.

Please complete the following information:

(Applicants asserting a preference based on their spouse’s service, should provide this

information as it pertains to their spouse).

Service Entry Date ____________________

Release Date ____________________

Branch _________________________

Veteran’s Social Security # _________________________

Type of Discharge _________________________ (attach DD214 or other certification)

Did or does the Veteran have a Veteran disability rating from the VA?

YES __________

NO __________

If yes, is the present disability rating

__________ Less than 30% __________ or more

Have you received/asserted a Veteran’s Preference when applying for any job after October 1, 1987?

__________ YES __________ NO

Have you received employment after October 1, 1987, as a result of asserting Veteran’s Preference?

__________ YES __________ NO

I hereby certify that the information provided above is true and correct to the best of my knowledge. I understand that falsification of

this information is a criminal violation and may subject me to prosecution and possible incarceration and/or fine and will result in my

dismissal if employed. I have received notice of the appropriate procedures to follow in order to initiate an investigation into any

noncompliance with the Veteran’s Preference laws.

_____________________________________________

______________________________

APPLICANT’S SIGNATURE

DATE

_____________________________________________

______________________________

HR DEPARTMENT

DATE

City Of Niceville Application For Veteran'S Preference Page 2

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