Form OAR 839-006-0440 Veteran's Preference Form - Oregon

Form OAR839-006-0440 is a Oregon Secretary of State - issued form also known as the "Veteran's Preference Form".

A PDF of the latest Form OAR839-006-0440 can be downloaded below or found on the Oregon Secretary of State Forms and Publications website.

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VETERAN’S PREFERENCE FORM
Under Oregon law, veterans who meet minimum qualifications for a position may be eligible for employment
preference. Please read the following checklist carefully, and check the box for each item that applies to you.
IN ORDER TO BE ELIGIBLE TO RECEIVE VETERAN’S PREFERENCE, THIS COMPLETED FORM AND THE REQUIRED SIJPPORTING
DOCUMENTATION MUST BE SUBMITTED WITH YOUR EMPLOYMENT APPLICATION MATERIALS. PREFERENCE WILL NOT BE
AWARDED WITHOUT APPROPRIATE DOCUMENTATION.
A.
QUALIFIED VETERAN QUESTIONS: You may claim veteran's preference if you check at least one box below
and provide proof of eligibility by submitting a copy of your form DD-214 or DD-215 that includes your discharge
status.
I served on active duty with the Armed Forces of the United States:
 For a period of more than 90 consecutive days beginning on or before January 31, 1955 and was
Discharged or released under honorable conditions, or
 For a period of more than 178 consecutive days beginning after January 31, 1955 and was discharged or
released from active duty under honorable conditions, or
 For 176 days or less and was discharged or released from active duty under honorable conditions because
of a service-connected disability, or
 For 178 days or less and was discharged or released from active duty under honorable conditions and
have a disability rating from the United States Department of Veterans Affairs, or
 For at least one day in a combat zone and was discharged or released from active duty under honorable
conditions,
OR
 I received a combat or campaign ribbon or an expeditionary medal for service in the Armed Forces of the
United States and was discharged or released from activity duty under honorable conditions, or
 I am receiving a nonservice-connected pension from the United States Department of Veterans Affairs.
Please see the next page for applicable definitions.
B.
QUALIFIED DISABLED VETERAN QUESTIONS: You may claim additional employment preference if you can
check at least one box below and provide proof of eligibility by submitting both of the documents listed below.
1. A copy of your DD-214 or DD-215, Certificate of Release or Discharge, Copy 4, and
2. A public employment veteran’s disability preference letter from the United States Department of
Veterans’ Affairs (unless the information is included in the DD Form 214/215). To order the letter, call 1-
800-827-1000 and request a public employment preference letter.
 I have a disability rating through the United States Department of Veterans Affairs; or
 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.
I hereby claim veteran’s preference points 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.
Print Name
Service Number
Signature of Applicant
Date
Position Applied For
VETERAN’S PREFERENCE FORM
Under Oregon law, veterans who meet minimum qualifications for a position may be eligible for employment
preference. Please read the following checklist carefully, and check the box for each item that applies to you.
IN ORDER TO BE ELIGIBLE TO RECEIVE VETERAN’S PREFERENCE, THIS COMPLETED FORM AND THE REQUIRED SIJPPORTING
DOCUMENTATION MUST BE SUBMITTED WITH YOUR EMPLOYMENT APPLICATION MATERIALS. PREFERENCE WILL NOT BE
AWARDED WITHOUT APPROPRIATE DOCUMENTATION.
A.
QUALIFIED VETERAN QUESTIONS: You may claim veteran's preference if you check at least one box below
and provide proof of eligibility by submitting a copy of your form DD-214 or DD-215 that includes your discharge
status.
I served on active duty with the Armed Forces of the United States:
 For a period of more than 90 consecutive days beginning on or before January 31, 1955 and was
Discharged or released under honorable conditions, or
 For a period of more than 178 consecutive days beginning after January 31, 1955 and was discharged or
released from active duty under honorable conditions, or
 For 176 days or less and was discharged or released from active duty under honorable conditions because
of a service-connected disability, or
 For 178 days or less and was discharged or released from active duty under honorable conditions and
have a disability rating from the United States Department of Veterans Affairs, or
 For at least one day in a combat zone and was discharged or released from active duty under honorable
conditions,
OR
 I received a combat or campaign ribbon or an expeditionary medal for service in the Armed Forces of the
United States and was discharged or released from activity duty under honorable conditions, or
 I am receiving a nonservice-connected pension from the United States Department of Veterans Affairs.
Please see the next page for applicable definitions.
B.
QUALIFIED DISABLED VETERAN QUESTIONS: You may claim additional employment preference if you can
check at least one box below and provide proof of eligibility by submitting both of the documents listed below.
1. A copy of your DD-214 or DD-215, Certificate of Release or Discharge, Copy 4, and
2. A public employment veteran’s disability preference letter from the United States Department of
Veterans’ Affairs (unless the information is included in the DD Form 214/215). To order the letter, call 1-
800-827-1000 and request a public employment preference letter.
 I have a disability rating through the United States Department of Veterans Affairs; or
 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.
I hereby claim veteran’s preference points 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.
Print Name
Service Number
Signature of Applicant
Date
Position Applied For
DEFINITIONS
Armed Forces means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard, including the reserve
components thereof. (Title 38 USC Part I Chapter 1 Section 101). Reserve components mean:
1. The Army Reserve;
2. The Navy Reserve;
3. The Marine Corps Reserve;
4. The Air Force Reserve;
5. The Coast Guard Reserve;
6. The Army National Guard of the United States; and
7. The Air National Guard of the United States.
Active duty does not include attendance at a school under military orders, except schooling incident to an active enlistment
or a regular tour of duty, or normal military training as a reserve officer or member of an organized reserve or a National
Guard unit.
Combat zone means an area designated by the President of the United States by executive order in which, on the dates
designated by executive order, the Armed Forces of the United States are or have engaged in combat.
Veteran means a person who:
1. Served on active duty with the Armed Forces of the United States:
a.
For a period of more than 90 consecutive days beginning on or before January 31, 1955, and was discharged or
released under honorable conditions;
b. For a period of more than 178 consecutive days beginning after January 31, 1955, and was discharged or released
from active duty under honorable conditions;
c.
For 178 days or less and was discharged or released from active duty under honorable conditions because of a
service-connected disability;
d. For 178 days or less and was discharged or released from active duty under honorable conditions and has a
disability rating from the United States Department of Veterans Affairs; or
e. For at least one day in a combat zone and was discharged or released from active duty under honorable conditions;
2. Received a combat or campaign ribbon or an expeditionary medal for service in the Armed Forces of the United States
and was discharged or released from active duty under honorable conditions; or
3. Is receiving a nonservice-connected pension from the United States Department of Veterans Affairs.
Disabled veteran means a person who has a disability rating from the United States Department of Veterans Affairs, a person
whose discharge or release from actin e duty was for a disability incurred or aggravated in the line of duty or a person who was
awarded the Purple Heart for wounds received in combat.
OAR 839-006-0440

Download Form OAR 839-006-0440 Veteran's Preference Form - Oregon

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