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: _____________________ Discharge Date: ____________________
Branch of Service: ____________________________
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 non-compliance with
the Veterans’ Preference laws.
____________________________________ ________________________________
Applicant's Signature Date
Should the position for which you are applying be filled by someone who does not qualify for Veterans’ Preference and/or should you feel
that proper consideration of the Veterans’ Preference has not been provided to you, please contact the Seminole County Human Resources
Division at 407-665-7944, 1101 East First Street, Sanford, Fl 32771.
You also have the right to initiate an investigation by the Florida Department of Veterans’ Affairs. You may do so by notifying the State of
Florida, Department of Veterans’ Affairs, 9500 Bay Pines Blvd., St. Petersburg, Fl 33708, within 21 calendar days from the date you
received notice that you were not selected for the position. If a notice of hiring decision is not given, a complaint may be filed at any time.
Veterans’ Preference Status:
Qualified
Disqualified
Initials___________
Form No. 0007 (Rev. Dec 2015)