"Election of Veteran's Preference Form" - City of Medina, Minnesota

Election of Veteran's Preference Form is a legal document that was released by the Administration Department - City of Medina, Minnesota - a government authority operating within Minnesota. The form may be used strictly within City of Medina.

Form Details:

  • Released on May 7, 2012;
  • The latest edition currently provided by the Administration Department - City of Medina, Minnesota;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

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Download "Election of Veteran's Preference Form" - City of Medina, Minnesota

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Revised 5/7/2012
Election of Veteran’s Preference Form
(Minnesota Statute 43A.11)
Name: __________________________________________
(Please Print)
Are you eligible to claim veteran’s preference?
____Yes
____No (if “no” is marked, please stop here)
Do you wish to claim veteran’s preference if you achieve a passing score?
____Yes
____No
If yes, please check the preference you are claiming:
___ Veteran – defined as a U.S. citizen or resident alien who separated under honorable
conditions, and
1. has served on active duty for at least 181 consecutive days, or
2. was discharged by reason of disability incurred while on active duty, or
3. has met active duty requirements as defined by the Code of Federal Regulations, or
4. has active military service certified under section 401, Public Law Number 95-202
In addition, you cannot be currently receiving a monthly veteran’s pension based exclusively
on length of service. Attach a copy of your DD214 in order to receive 10 points.
___ Disabled Veteran – defined as a veteran having a compensable service connected disability
as adjudicated by the U.S. Veterans Administration or the retirement board of one of the
branches of the Armed Forces, which disability is currently existing. (Attach a copy of
your DD214 and FL 802 (or an equivalent letter from a service retirement board) to
receive 15 points.
___ Spouse of a deceased veteran. Attach a copy of your marriage certificate, the veteran’s
DD214 and the death certificate to receive 10 points.
___ Spouse of a disabled veteran who is unable to use preference due to disability. Attach a copy
of your marriage certificate, the veteran’s DD214 and FL802 (or an equivalent letter from
a service retirement board) to receive 15 points.
AFFIDAVIT:
I hereby claim veteran’s preference for this vacancy and certify that all the information given is
true, complete, and the best of my knowledge.
I hereby authorize the Veteran’s Administration to release information necessary to process this
application to the City of Medina.
SIGNATURE:_____________________________________ DATE:_______________
Revised 5/7/2012
Election of Veteran’s Preference Form
(Minnesota Statute 43A.11)
Name: __________________________________________
(Please Print)
Are you eligible to claim veteran’s preference?
____Yes
____No (if “no” is marked, please stop here)
Do you wish to claim veteran’s preference if you achieve a passing score?
____Yes
____No
If yes, please check the preference you are claiming:
___ Veteran – defined as a U.S. citizen or resident alien who separated under honorable
conditions, and
1. has served on active duty for at least 181 consecutive days, or
2. was discharged by reason of disability incurred while on active duty, or
3. has met active duty requirements as defined by the Code of Federal Regulations, or
4. has active military service certified under section 401, Public Law Number 95-202
In addition, you cannot be currently receiving a monthly veteran’s pension based exclusively
on length of service. Attach a copy of your DD214 in order to receive 10 points.
___ Disabled Veteran – defined as a veteran having a compensable service connected disability
as adjudicated by the U.S. Veterans Administration or the retirement board of one of the
branches of the Armed Forces, which disability is currently existing. (Attach a copy of
your DD214 and FL 802 (or an equivalent letter from a service retirement board) to
receive 15 points.
___ Spouse of a deceased veteran. Attach a copy of your marriage certificate, the veteran’s
DD214 and the death certificate to receive 10 points.
___ Spouse of a disabled veteran who is unable to use preference due to disability. Attach a copy
of your marriage certificate, the veteran’s DD214 and FL802 (or an equivalent letter from
a service retirement board) to receive 15 points.
AFFIDAVIT:
I hereby claim veteran’s preference for this vacancy and certify that all the information given is
true, complete, and the best of my knowledge.
I hereby authorize the Veteran’s Administration to release information necessary to process this
application to the City of Medina.
SIGNATURE:_____________________________________ DATE:_______________