Veterans Preference Form - City Of Barnum printable pdf download

VETERANS’ PREFERENCE

COMPLETE THIS FORM ONLY IF YOU ARE CLAIMING VETERANS’ PREFERENCE NOTE: COPY OF “MEMBER

COPY 4” VETERAN’S DD214 MUST BE ATTACHED (Veteran is defined by Minn. Stat. § 197.447)

You must submit a PHOTOCOPY of your “Member Copy 4” of your

the full period called or ordered for federal, active duty and be a United

DD214 or other military documents to substantiate the service

States citizen or resident alien. Veteran’s preference may be used by

information requested on the form. Claims not accompanied by

the surviving spouse of a deceased veteran, who died on active duty or

proper documentation will not be processed. For assistance in

as a result of active duty, and by the spouse of a disabled veteran who is

obtaining a copy of your “member Copy 4” of your DD214, contact

unable to qualify because of the disability.

your County Veterans’ Service Office.

The City of Barnum operates under a point preference system, which

To qualify for preference on a promotional exam, a veteran must have

earned a passing exam score and received a USDVA active duty service

awards points to qualified veterans to supplement their application.

connected disability rating of 50% or more. For a promotional exam, a

Ten (10) points are granted to non-disabled veterans on open

qualified disabled veteran is entitled to be granted five ( 5) points.

competitive examinations; Fifteen (15) points are awarded if the

Disabled veterans eligible for such preference may use the five points

veteran has a service connected compensable disability as certified by

preference only for the first promotion after securing employment with

the U.S. Department of Veterans Affairs (USDVA).

the City of Barnum.

To qualify for preference for a competitive exam, you must have

Claims must be made on the form below and submitted with your

earned a passing score and been separated under honorable

application by the application deadline of the position for which you are

conditions from any branch of the armed forces of the United States

applying. If the “Member Copy 4” DD214 is submitted to our office

after having served on active duty for 181 consecutive days, or by

separate from this sheet, please attach a note with it indicating the

reason of disability incurred while serving on active duty, or after

position for which you are applying and your present address.

having served

Name (Last)

(First)

(MI)

Social Security Number

Position For Which You Applied

Closing Date:

Address (Street)

(City)

(State)

(Zip)

Phone Number

Are you a US Citizen or Resident Alien?

YES

VETERAN (10 points):

(“Member Copy 4” of DD214 or DD215 must be submitted to receive points)

Honorably discharged veteran

Yes

DISABLED VETERAN (15 points):

(“Member Copy 4” of DD214 and USDVA letter of disability rating decision of 10% or more must be submitted to receive points)

Percent of Disability:

_____%

Have you ever been promoted within the City of _______ employment?

Yes

SPOUSE OF DECEASED VETERAN (10 points or 15 if the veteran was disabled at time of death):

(“Member Copy 4” of DD214 or DD215, photocopy of marriage certificate, spouse’s death certificate and proof veteran died on or as a

result of active duty must be submitted to receive points. You are ineligible to receive points if you have remarried or were divorced

from the veteran.)

Date of Death: _________

Have you remarried?

Yes

SPOUSE OF DISABLED VETERAN (15 points):

(“Member Copy 4” of DD214 or DD215 and USDVA letter of disability rating decision of 10% or more must be submitted to receive

points.)

How does Veteran’s disability prevent performance of a stated job “requirement?” Due to the veteran’s service-connected

disability the veteran is unable to qualify for this position because (be specific):

AFFIDAVIT: I hereby claim Veterans’ Preference points for this examination and swear/affirm that the information given is

true, complete and correct to the best of my knowledge. I hereby acknowledge that I am responsible to obtain the required

Veterans’ Preference verification documents and submit them to the City of Barnum by the required application deadline.

_____________________________________________

___________________________

Signature

Date

Veterans Preference Form - City Of Barnum

Related Articles

Related forms

Related Categories