Form CALHR1093 "Veterans' Preference for Examinations" - California

What Is Form CALHR1093?

This is a legal form that was released by the California Department of Human Resources - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the California Department of Human Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CALHR1093 by clicking the link below or browse more documents and templates provided by the California Department of Human Resources.

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Download Form CALHR1093 "Veterans' Preference for Examinations" - California

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Veterans' Preference for Examinations
Print Form
California Department of Human Resources
Reset Form
State of California
Identify your application basis by checking one of the boxes below.
Note: each application type requires the completion of different sections of this form.
Application Basis:
Self - Veteran
Self - Active Military
Spouse - of deceased veteran
Spouse - of 100% disabled veteran
Complete Sections:
1, 2 and 4
1, 2, 4 and CalHR1094
1, 2 and 4
1, 2, 3 and 4
Applying for the Provisional Transitional Waiver? Complete this form and include a completed CalHR 1094.
Updating Veteran’s Preference status based on discharge (i.e. received PTW). Complete this form and include DD214.
1. Applicant Information
Name
Date of Birth
Social Security #
Address (Street, City, State, ZIP)
ECOS ID #
Telephone Number
E-Mail Address
(Optional)
2. Veteran's Information
Name of Veteran
Date of Birth
Social Security #
Service Summary
Branch of Service
Entry Date
Separation Date
Character of Service
3. Disability Preference
Disability Percentage VA Claim Number
US VA Regional Office where your disability claim is filed
4. Certification and Signature
Documents Attached
Documents Required for Application Basis
DD214
Veteran, Spouse of Deceased Veteran, or Spouse of 100% Disabled Veteran
CalHR 1094
Active Military
Marriage Certificate
Spouse of Deceased Veteran, or Spouse of 100% Disabled Veteran
Spouse's Death Certificate
Spouse of Deceased Veteran
Disability Award Letter
Spouse of 100% Disabled Veteran
I hereby certify that the above information is true and correct to the best of my knowledge. I understand that
providing false information will result in my disqualification to participate in the Veteran’s Preference Program.
Signature
Date
CalHR 1093
(rev 03/2018)
Page 1 of 3
Veterans' Preference for Examinations
Print Form
California Department of Human Resources
Reset Form
State of California
Identify your application basis by checking one of the boxes below.
Note: each application type requires the completion of different sections of this form.
Application Basis:
Self - Veteran
Self - Active Military
Spouse - of deceased veteran
Spouse - of 100% disabled veteran
Complete Sections:
1, 2 and 4
1, 2, 4 and CalHR1094
1, 2 and 4
1, 2, 3 and 4
Applying for the Provisional Transitional Waiver? Complete this form and include a completed CalHR 1094.
Updating Veteran’s Preference status based on discharge (i.e. received PTW). Complete this form and include DD214.
1. Applicant Information
Name
Date of Birth
Social Security #
Address (Street, City, State, ZIP)
ECOS ID #
Telephone Number
E-Mail Address
(Optional)
2. Veteran's Information
Name of Veteran
Date of Birth
Social Security #
Service Summary
Branch of Service
Entry Date
Separation Date
Character of Service
3. Disability Preference
Disability Percentage VA Claim Number
US VA Regional Office where your disability claim is filed
4. Certification and Signature
Documents Attached
Documents Required for Application Basis
DD214
Veteran, Spouse of Deceased Veteran, or Spouse of 100% Disabled Veteran
CalHR 1094
Active Military
Marriage Certificate
Spouse of Deceased Veteran, or Spouse of 100% Disabled Veteran
Spouse's Death Certificate
Spouse of Deceased Veteran
Disability Award Letter
Spouse of 100% Disabled Veteran
I hereby certify that the above information is true and correct to the best of my knowledge. I understand that
providing false information will result in my disqualification to participate in the Veteran’s Preference Program.
Signature
Date
CalHR 1093
(rev 03/2018)
Page 1 of 3
OVERVIEW
Effective January 1, 2014, Government Code (GC), section 18973.1 provides for Veterans' Preference (VP) to qualifying Veterans
who are successful in an examination. In accordance with GC section 18973.1, all individuals who achieve a passing score on an
entrance examination shall be certified in rank 1 of the eligibility list, regardless of score. Once an individual achieves permanent
civil service status he or she is no longer eligible to receive VP.
If you are currently on an open eligibility list, you may need to provide a copy of your approval letter to the testing office that
administered your examination. If your current eligibility record does not reflect VP or your VP is not listed in your CalCareer
account, contact the testing department.
Individuals who received VP are not eligible for Career Credits pursuant to sections 18950.1, 18951, and 18951.5.
ELIGIBILITY REQUIREMENTS
Competitors in state civil service entrance examinations* are entitled to have VP applied to their eligibility upon achieving a passing
score in the overall examination, if the following criteria are met:
(1) Have never achieved permanent civil service status; AND
(2) Have served in the U.S. Armed Forces as defined in Government Code Section 18540; AND
(3) Qualify as veterans**,
Any member of the armed forces who takes an open entrance examination while still on active duty and achieves a place on an
eligible list may have VP applied, if qualification for such preference is active within twelve (12) months of eligibility being
established.
*Open entrance examinations are state civil service examinations given in either open or open non promotional basis.
**Provisional Transitional VP may be available for select active service members within six months of separation from active
service.
Submit this form, with all required documents (identified in section 4) to:
California Department of Human Resources
Attn: Selection Division
1515 “S” St., North Building, Suite 500
Sacramento, CA 95811
INSTRUCTIONS
1. Complete this form, which includes your name, date of birth, social security number, address, ECOS ID # (optional),
telephone number, e-mail address, branch of service, entry date, separation date and character of service.
2. Include a legible copy of your DD214, or other official discharge documents, showing your enlistment and discharge dates,
net active service, branch of service, social security number, birth date, and your character of service (e.g., Honorable).
3. If you are the un-remarried, surviving spouse of a veteran, in addition to the above items 1 and 2, please submit copies of
your marriage certificate, and spouse's death certificate or other documentary evidence of death.
4. If you are the spouse of a 100 percent disabled veteran, in addition to the above items 1 and 2. please submit copies of
your marriage certificate, spouse's official discharge documents, and a document provided by the United States Dept. of
Veterans Affairs (Disability Award Letter) substantiating the 100 percent disablement.
5. If you are applying for provisional VP the Provisional Transitional Waiver form, CalHR 1094, must be included.
DEFINITIONS
“Veteran” means any person who has served full-time for 30 days or more in the armed forces in time of war or in time of peace in
a campaign or expedition for service in which a medal has been authorized by the government of the United States, or during the
period September 16, 1940 to January 31, 1955, or who has served at least 181 consecutive days since January 31, 1955, AND
who has been discharged or released under conditions other than dishonorable, but does not include any person who served only
in auxiliary or reserve components of the armed forces whose service therein did not exempt him or her from the operation of the
Selective Training and Service Act of 1940.
“100 percent disabled veteran” means any veteran as defined above who is currently declared by the United States Department of
Veterans Affairs to be 100 percent disabled as a result of his or her service.
“Permanent civil service status” is the status of an employee who is lawfully retained after completion of the probationary period.
This includes permanent intermittent, part-time, and full-time appointments.
Questions? Please call (866) 844-8671.
CalHR 1093
(rev 03/2018)
Page 2 of 3
PRIVACY NOTICE
This notice is provided pursuant to the Information Practices Act of 1977. The California
Department of Human Resources (CalHR), Selection Division, and the Veterans' Preference
Administrator are requesting the information specified on this form pursuant to Government
Code Sections 1151, 1153, Section 6011 and 6051 of the Internal Revenue Code, and
Regulation 4, Section 404.1256, Code of Federal Regulations, under Section 218, Title II of
the Social Security Act.
The information collected will be used for administering Veterans' Preference benefits and will
be disclosed to the Selection Division administrator(s). Individuals should not provide
personal information that is not requested or required.
The submission of all information requested is mandatory unless otherwise noted. If you fail
to provide the information requested, CalHR will not be able to process your request for
Veterans' Preference benefits.
Department Privacy Policy
The information collected by CalHR is subject to the limitations in the Information Practices
Act of 1977 and state policy. For more information on how we care for your personal
information, please read our Privacy Policy on CalHR's website (CalHR.ca.gov).
Access to Your Information
Information provided on this form will be maintained in confidential files of CalHR for five
years. Individuals have the right of access to copies of this form on request. Send requests to:
CalHR Privacy Officer
1515 S Street, North Building, Suite 500
Sacramento, California 95811-7258
916-324-0455
CalHRPrivacy@CalHR.ca.gov
CalHR 1093
(rev 03/2018)
Page 3 of 3
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