Application Form for Veterans Preference - County of San Luis Obispo, California

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APPLICA TION FOR VETERANS PREFERENCE
COUNTY OF SAN LUIS OBISPO, CALIFORNIA
INSTRUCTIONS:
Present this form to the Veterans Service Office, 801 Grand Ave., San Luis Obispo, California, WITH required evidence as follows:
VETERANS: Documentary evidence of honorable wartime service in the Armed Forces. (DD214)
DISABLED VETERANS:
Documentary evidence of honorable wartime service in the Armed Forces (DD214); and Veterans
Administration letter dated within the last year verifying service connected disabled status. V.A. letter must be submitted with each
employment application.
SPOUSE OF DISABLED VETERAN: Documentary evidence of veteran’s honorable wartime service in the Armed Forces (DD214);
evidence of permanent and total disability of veteran; marriage certificate.
WIDOWS: Documentary evidence of husband’s honorable wartime service in the Armed Forces (DD214); marriage certificate;
evidence of death of veteran.
PLEASE PRINT OR TYPE:
Social Security No. __________________________
_________________________________________
_________________________________________
__________________
(Last name)
(First Name)
(Middle Initial)
Name used in service ___________________________________________________________________________________________________
_________________________________________
_________________________________________
__________________
(Mailing address, Street or P.O Box)
(City)
(State)
_________________________________________
_________________________________________
__________________
(Date of Birth)
(Place of Birth)
(Phone Number)
SERVICE INFORMATION: (If more than three periods of service, continue on reverse side.)
ENTERED ACTIVE DUTY
SERIAL NO.
SEPARATED FROM SERVICE
CHARACTER OF
SERVICE
SEPARATION
BRANCH
DATE
PLACE
DATE
PLACE
SIGNATURE OF APPLICANT:
I HEREBY CERTIFY that the statements on this application are true. I agree and understand that any misrepresentation of material facts herein
may cause forfeiture of all right to any employment in service of the County of San Luis Obispo.
___________________________________
_________________________________________________________
(Date of Application)
(Signature of Applicant)
DO NOT WRITE BELOW THIS LINE
CERTIFICATION:
I HEREBY CERTIFY that I have examined the documentary evidence of applicant and that status of eligibility for Veterans Preference is as
follows:
(Date)
APROVED: _______________________________ _________________________________________ ________________________________
PENDING: _______________________________
(Signature)
(Title)
REJECTED: ______________________________
REMARKS: ___________________________________________________________________________________________________________
This application will be kept on file in the office of the Veterans Service Officer. Eligibility for Veterans Preference will be verified by the Civil
Service Commission following examination for County Employment.
P:\Administration\FORMS\APPLICATION FOR VETERANS PREFERENCE.doc

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