"Veteran Preference Questionnaire Form" - City of Bloomington, Minnesota

Veteran Preference Questionnaire Form is a legal document that was released by the Human Resources Department - City of Bloomington, Minnesota - a government authority operating within Minnesota. The form may be used strictly within City of Bloomington.

Form Details:

  • Released on May 1, 2012;
  • The latest edition currently provided by the Human Resources Department - City of Bloomington, Minnesota;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Human Resources Department - City of Bloomington, Minnesota.

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Download "Veteran Preference Questionnaire Form" - City of Bloomington, Minnesota

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IMPORTANT NOTICE
The City of Bloomington requires a HANDWRITTEN SIGNATURE on all
employment applications. Job seekers MUST SUBMIT A PAPER COPY of
this application; electronic submissions will not be accepted.
This form can be filled out and printed using Adobe Acrobat Reader.
THE PRINTOUT MAY BE YOUR ONLY RECORD of the data you entered.
If you have Acrobat Reader 7 or later, you may be able to save the form
with your entries.
Tip
Turning off the
+
symbol next to the fields
The Text Field Overflow symbol appears as a plus sign next to form fields and
can cover text when the file is printed. For best results, turn this preference off.
1. Choose File > Save to save the file to your computer. Then open Acrobat
Reader and the file.
2. Choose Edit > Preferences (Windows) or Acrobat > Preferences (Mac OS),
and select Forms on the left. Unclick the third check box down, “Show text
field overflow indicator.”
IMPORTANT NOTICE
The City of Bloomington requires a HANDWRITTEN SIGNATURE on all
employment applications. Job seekers MUST SUBMIT A PAPER COPY of
this application; electronic submissions will not be accepted.
This form can be filled out and printed using Adobe Acrobat Reader.
THE PRINTOUT MAY BE YOUR ONLY RECORD of the data you entered.
If you have Acrobat Reader 7 or later, you may be able to save the form
with your entries.
Tip
Turning off the
+
symbol next to the fields
The Text Field Overflow symbol appears as a plus sign next to form fields and
can cover text when the file is printed. For best results, turn this preference off.
1. Choose File > Save to save the file to your computer. Then open Acrobat
Reader and the file.
2. Choose Edit > Preferences (Windows) or Acrobat > Preferences (Mac OS),
and select Forms on the left. Unclick the third check box down, “Show text
field overflow indicator.”
VETERAN PREFERENCE QUESTIONNAIRE
(Must be completed by all veterans and submitted with your completed application form.)
City of Bloomington, Minnesota
This questionnaire is to determine your status as a veteran under the Veteran’s Preference Statute, Minnesota Statutes, 43A.11.
Veteran's Preference Statutes provide a 10 point preference to those individuals who have attained a passing score on the
entrance exam and who have received an Honorable Discharge or Separation after serving more than 180 consecutive days in the
military service for purposes other than training. (Fifteen [15] points if a disabled veteran.)
Please check the statement which best describes your current Veteran’s status:
I am a Veteran (please complete items 1-10 and sign and date the bottom of this form).
I am the spouse of a deceased Veteran (please complete items 1-10 and sign and date the bottom of this form).
I am the spouse of a disabled Veteran who is unable to use the preference due to the disability (please
complete items 1-10 and sign and date the bottom of this form).
1.
Name ______________________________________
2. S.S. # _______________________________
3.
Address ________________________________________________________________________________
(City)
(State)
(Zip Code)
4.
Position for which applying ________________________________________________________________
5.
If you achieve the minimum passing rating, do you wish to apply your veteran's preference bonus points?
Yes ____
No ____
6.
If a spouse of a deceased or disabled veteran, list veteran's name: ___________________________________
7.
Period of active duty: From: __________________________
To: _____________________________
(Do not include short training periods of active duty with a reserve unit. You must have served with a unit that was on
active duty, not one on reserve status.)
8.
Branch of Service: _________________________________
Service No.: ________________________
9.
Rank at discharge: _______________________
Type of separation or discharge: __________________
(Honorable, General, Etc.)
10.
Service connected disability:
Type _________________________
Percent ____________________
It is necessary for you to provide the City with a copy of your form DD-214. Disabled veterans must also supply form
FL-802 or an equivalent letter from a service retirement board. Spouses applying for preference points must supply
their marriage certificate, the veteran's DD-214 and FL-802 or death certificate.
Your veteran's preference points cannot be considered without supporting documentation. If the documentation is not
attached, it must be received in the Human Resources Office no later than 7 calendar days after the deadline date for the
position.
My supporting documentation: is attached 
will be submitted within 7 calendar days 
I swear that the above statements are true and accurate to the best of my knowledge and belief.
________________________________________
_______________________________________
(Signature)
(Date)
j/forms/vetprefNEOGOV.doc
(5/12)
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