Sample Veterans' Preference Form (Ors 408.230)

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Veterans’ Preference Form (ORS 408.230)
Veterans who meet the minimum qualifications for a position open for recruitment may
be eligible for preference in employment under Oregon law. If you are a Qualified
Veteran or Qualified Disabled Veteran and would like to be granted preference in the
selection and hiring process for a specific posted job, please fill out this Veterans’
Preference Form and provide proof of eligibility by submitting a copy of form DD-214 or
215 (copy 4). This completed form and required supporting documentation must be
submitted with your application in order for consideration for Veterans’ Preference.
Qualified Veteran Questions: Veterans’ preference may be claimed if you check at
least one of the boxes below and provide proof via form DD-214 or 215 (Copy 4)
ORS 408.225(f) – 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
___ 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
___ For a period of 178 days or less and was discharged or released from active duty under honorable
conditions because of a service due to a service related disability
___ For a period of 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
___ For at least one day in a combat zone and was discharged or released from active duty under
honorable conditions
___ And 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
___ And am receiving a nonservice – connected pension from the United States Department of Veterans
Affairs
Qualified Disabled Veteran Questions: Additional preference may be claimed if you
check at least one box below and provide proof of eligibility via a copy of DD214 or 15,
Copy 4, and a public employment preference letter from the United States Department
of Veteran’s Affairs (letter may be requested by calling 800-827-1000)
___ I am entitled to disability compensation under laws administered by 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.
Veterans’ Preference Form (ORS 408.230)
Veterans who meet the minimum qualifications for a position open for recruitment may
be eligible for preference in employment under Oregon law. If you are a Qualified
Veteran or Qualified Disabled Veteran and would like to be granted preference in the
selection and hiring process for a specific posted job, please fill out this Veterans’
Preference Form and provide proof of eligibility by submitting a copy of form DD-214 or
215 (copy 4). This completed form and required supporting documentation must be
submitted with your application in order for consideration for Veterans’ Preference.
Qualified Veteran Questions: Veterans’ preference may be claimed if you check at
least one of the boxes below and provide proof via form DD-214 or 215 (Copy 4)
ORS 408.225(f) – 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
___ 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
___ For a period of 178 days or less and was discharged or released from active duty under honorable
conditions because of a service due to a service related disability
___ For a period of 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
___ For at least one day in a combat zone and was discharged or released from active duty under
honorable conditions
___ And 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
___ And am receiving a nonservice – connected pension from the United States Department of Veterans
Affairs
Qualified Disabled Veteran Questions: Additional preference may be claimed if you
check at least one box below and provide proof of eligibility via a copy of DD214 or 15,
Copy 4, and a public employment preference letter from the United States Department
of Veteran’s Affairs (letter may be requested by calling 800-827-1000)
___ I am entitled to disability compensation under laws administered by 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 Veterans’ Preference, have attached proof of eligibility as directed 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.
I, _________________________ am claiming Veterans’ Preference and certify that
I am eligible to do so.
__ 5 points
__ 10 points
Signature: _______________________________
Date: ____________________
Position Applied For: __________________________________________________
If you have any specific questions please contact Human Resources
XXX-XXX-XXXX or
email@cisoregon.org
This form and supporting documentation must be received by the Human Resources
Department no later than the closing time and date of the job posting.

Download Sample Veterans' Preference Form (Ors 408.230)

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