"Veteran's Preference Application" - City and County of San Francisco, California

Veteran's Preference Application is a legal document that was released by the Department of Human Resources - City and County of San Francisco, California - a government authority operating within California. The form may be used strictly within City and County of San Francisco.

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Ci ty and County of San Francisco
Department of Human Resources
Carol Isen
London Breed
Human Resources Director
Mayor
FOR OFFICE USE ONLY
CITY AND COUNTY OF SAN FRANCISCO
Eligible 5%
Eligible 10%
VETERAN’S PREFERENCE APPLICATION
Not Eligible
Analyst
Date
Position you are applying for:
Social Security Number:
Class#
Title
Last Name:
First Name:
Middle Initial:
Check One:
I am an Eligible Veteran, as defined in CSC Rule 111.36 (complete items 1, 2, and 6).
I am a Disabled Veteran, as defined in CSC Rule 111.37 (complete items 1, 2, 3 and 6).
I am the un-remarried widow/widower or surviving domestic partner of an Eligible Veteran per CSC
Rule 111.38.1 (complete items 1, 2, 4, 5 and 6).
I am the un-remarried widow/widower or surviving domestic partner of a Disabled Veteran per CSC
Rule 111.38.2 (complete items 1, 2, 3, 4, 5 and 6).
1. Veteran’s Qualifying Service: (attach legible copy of DD214)
DATE ENTERED
DATE SEPARATED FROM
TYPE OF SEPARATION/
ACTIVE DUTY
ACTIVE DUTY
CHARACTER OF DISCHARGE
2. Have you ever been awarded Veteran’s Preference on a City and County of San Francisco
eligible list or score report? No  Yes 
If Yes, indicate class number(s) and approximate date(s):
3. Disabled Veteran Preference: Complete this section if the Eligible Veteran has suffered a permanent
service-connected disability that is on record in the United States Veteran’s Administration.
Attach a copy of the award letter.
Claim number used by U.S. Veteran’s Administration C -
Veteran’s Administration Office where claim is now filed _______________________
4. Deceased Veteran’s Information:
Veteran’s Last Name:
Veteran’s First and Middle Name:
Veteran’s Date of Birth:
Veteran’s Social Security Number:
Veteran’s Military Serial Number:
5. Your relationship to the deceased Veteran at time of death
Have you subsequently remarried or entered into another domestic partnership?
Documentation of relationship must be submitted with this application, such as marriage certificate,
registration as domestic partner, veteran’s death certificate, etc.
6.
CERTIFICATION OF APPLICANT (read carefully): I hereby certify that all statements made in this application are true
and complete to the best of my knowledge. I understand that any false, incomplete, or incorrect statement, regardless of when it is
discovered, may result in my disqualification or dismissal from employment with the City and County of San Francisco.
Date
Signature of Applicant
Ci ty and County of San Francisco
Department of Human Resources
Carol Isen
London Breed
Human Resources Director
Mayor
FOR OFFICE USE ONLY
CITY AND COUNTY OF SAN FRANCISCO
Eligible 5%
Eligible 10%
VETERAN’S PREFERENCE APPLICATION
Not Eligible
Analyst
Date
Position you are applying for:
Social Security Number:
Class#
Title
Last Name:
First Name:
Middle Initial:
Check One:
I am an Eligible Veteran, as defined in CSC Rule 111.36 (complete items 1, 2, and 6).
I am a Disabled Veteran, as defined in CSC Rule 111.37 (complete items 1, 2, 3 and 6).
I am the un-remarried widow/widower or surviving domestic partner of an Eligible Veteran per CSC
Rule 111.38.1 (complete items 1, 2, 4, 5 and 6).
I am the un-remarried widow/widower or surviving domestic partner of a Disabled Veteran per CSC
Rule 111.38.2 (complete items 1, 2, 3, 4, 5 and 6).
1. Veteran’s Qualifying Service: (attach legible copy of DD214)
DATE ENTERED
DATE SEPARATED FROM
TYPE OF SEPARATION/
ACTIVE DUTY
ACTIVE DUTY
CHARACTER OF DISCHARGE
2. Have you ever been awarded Veteran’s Preference on a City and County of San Francisco
eligible list or score report? No  Yes 
If Yes, indicate class number(s) and approximate date(s):
3. Disabled Veteran Preference: Complete this section if the Eligible Veteran has suffered a permanent
service-connected disability that is on record in the United States Veteran’s Administration.
Attach a copy of the award letter.
Claim number used by U.S. Veteran’s Administration C -
Veteran’s Administration Office where claim is now filed _______________________
4. Deceased Veteran’s Information:
Veteran’s Last Name:
Veteran’s First and Middle Name:
Veteran’s Date of Birth:
Veteran’s Social Security Number:
Veteran’s Military Serial Number:
5. Your relationship to the deceased Veteran at time of death
Have you subsequently remarried or entered into another domestic partnership?
Documentation of relationship must be submitted with this application, such as marriage certificate,
registration as domestic partner, veteran’s death certificate, etc.
6.
CERTIFICATION OF APPLICANT (read carefully): I hereby certify that all statements made in this application are true
and complete to the best of my knowledge. I understand that any false, incomplete, or incorrect statement, regardless of when it is
discovered, may result in my disqualification or dismissal from employment with the City and County of San Francisco.
Date
Signature of Applicant