Veterans Preference Points Application Form - City Of Marshall Mn printable pdf download

VETERAN’S PREFERENCE

POINTS APPLICATION

Please return completed form to:

FOR OFFICE USE ONLY

City of Marshall Human Resources Office • 344 West Main Street • Marshall, MN 56258

Phone: 507/537-6790 • Fax: 507/537-6830 • E-mail:

Jobinformation@ci.marshall.mn.us

Date Received:

Website address:

You must submit a copy of your DD214—Member Copy 4 or other military documents to substantiate the service information requested on this

form. Claims not accompanied by proper documentation will not be processed. For assistance in obtaining military documents, contact the local

County Veterans’ Service Office at (507) 537-6729.

The City of Marshall operates under a point preference system, which awards points to qualified veterans to supplement their application. Points are awarded subject to the

provisions of MN Statute 43A.11. Ten (10) points are granted to non-disabled veterans on open competitive examinations; fifteen (15) points are awarded on open competitive

examinations if the veteran has a 10% or greater service connected compensable disability as certified by the U.S. Department of Veterans Affairs (USDVA).

Veteran’s Preference claims must be made on the form below and submitted with your application by the application deadline of the position for which you are applying. If the

DD214—Member Copy 4 or other supporting documentation is submitted to our office separate from this form, please attach a note with it indicating the position for which you are

applying and your present address.

Position you are applying for:

Name (Last)

(First)

(MI)

Are you a U.S. Citizen or Resident Alien?

Phone Number

 Yes

(

)

 No

Address (Street)

(City)

(State)

(Zip)

FOR OFFICE USE ONLY



5 points

10 points



15 points

Not approved

VETERAN—10 points

Member Copy 4 of DD214 or DD215 must be submitted to receive points

Honorably discharged veteran ………………………………………………  Yes

 No

DISABLED VETERAN—15 points on the passing score of an open competitive exam; 5 points on a promotional examination

rating for a first promotion only

Member Copy 4 of DD214 and USDVA letter of disability rating must be submitted to receive points

Honorably discharged veteran ………………………………………………  Yes

 No

Percent of Disability: _____%

 Yes

 No (entitled to 5 pts for first promotion only)

Have you ever been promoted in City of Marshall employment? ………

SPOUSE OF DECEASED VETERAN—10 points; 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.

 Yes

 No

Date of Death: _________

Have you remarried? ……………..

SPOUSE OF DISABLED VETERAN—15 points

Member Copy 4 of DD214 or DD215 and USDVA letter of disability rating decision 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 Marshall within 7 days of the application deadline.

Date:_______________________Signed:____________________________________________________________________________

Form 2014-10

Veterans Preference Points Application Form - City Of Marshall Mn

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