Fillable Veterans Hiring Preference Form (Page 2 of 2) in pdf

B. QUALIFIED DISABLED VETERAN QUESTIONS: You may claim disabled veterans’ hiring preference

if you can check at least one box in each of the two sections below and provide proof of eligibility by

submitting both:

A copy of your DD-214 or DD-215 showing your discharge status; and

2. A copy of your letter from the Department of Veterans Affairs stating your disability rating and dated

within the previous six months of the date of your employment application.

Section One

I am entitled to disability compensation under laws administered by the Department of Veterans Affairs;

I was discharged or released from active duty for a disability incurred or aggravated in the line of duty; or

I was awarded the Purple Heart for wounds received in combat.

Section Two

This application is to apply for a job with Yamhill County and I am officially certified as having service-

connected disabilities; or

This application is to apply for a promotion. After my initial regular status appointment to a Yamhill

County position, I was granted military leave to serve in the armed services for more than 178 days, and

then returned to County service.

C. SIGNATURE SECTION: This section must be completed.

I hereby claim veterans’ hiring preference and certify that the above information is true and correct. I understand

that any false statements may be cause for my disqualification or dismissal, regardless of when discovered.

Entry into Service: ___________________________ Discharge from Service: ___________________________

Branch of Service: _____________________________________

NOTE: This form must contain a written signature if you drop it off at the employment office or submit it via

mail or fax. This form must contain an electronic signature if submitted via e-mail. (If submitted with an

electronic signature, you will be required to sign this form at the interview, if you are selected to interview.)

Written Signature

Electronic Signature

(Type name. Electronic signature

required only when submitting form via e-mail.)

______________________________________

_______________________________________

Date _________________________________

Date __________________________________

Hiring preference will not be awarded without the appropriate documentation. You must submit a copy of this form, your DD-214

or DD-215 that shows discharge status, and a Yamhill County employment application for each position you are applying for. You

must submit these documents each time you apply for a position with Yamhill County. You will not receive hiring preference

consideration without these accompanying documents.

Form created 3/14/12

Veterans Hiring Preference Form Page 2