Veterans' Points Form - Scored Exam Positions - Oregon

This "Veterans' Points Form - Scored Exam Positions" is a part of the paperwork released by the Oregon Department of Veterans Affairs specifically for Oregon residents.

The latest fillable version of the document was released on April 4, 2012 and can be downloaded through the link below or found through the department's forms library.

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VETERANS’ POINTS FORM—SCORED EXAM POSITIONS
FULL NAME:
____________________
Under Oregon law most recently revised by the 2011 legislative session, veterans who successfully
complete an examination administered to establish eligibility may be granted preference points added
to the total combined examination score. If you think you qualify, please read the following
checklist carefully. Check the box for each item that is appropriate. You may receive assistance
from our office if you need further explanation or have special circumstances.
**Note: In order to assure that preference points are awarded at the time the eligible list is
established, this completed form and the required documentation must be submitted to Douglas
County Fire District No. 2 at the time you submit your application. If you submit your application
electronically, you must submit signed hardcopies of the required documentation no later than 4:30
PM on the closing date of the application period. If you are discharged/released later during the life of
the civil service list and otherwise qualify, you must submit this completed form and the required
documentation before points can be awarded.
You may be eligible for either ten points as a qualified disabled veteran or five points as a qualified
veteran (non disabled), but not both.
I am claiming ten (10) points as a qualified disabled veteran. Skip to part B: “Qualified
Disabled Veteran Criteria” on page 3; OR
I am claiming five (5) points as a qualified veteran (non disabled). Complete only part A below.
Revised 4-4-12
VETERANS’ POINTS FORM—SCORED EXAM POSITIONS
FULL NAME:
____________________
Under Oregon law most recently revised by the 2011 legislative session, veterans who successfully
complete an examination administered to establish eligibility may be granted preference points added
to the total combined examination score. If you think you qualify, please read the following
checklist carefully. Check the box for each item that is appropriate. You may receive assistance
from our office if you need further explanation or have special circumstances.
**Note: In order to assure that preference points are awarded at the time the eligible list is
established, this completed form and the required documentation must be submitted to Douglas
County Fire District No. 2 at the time you submit your application. If you submit your application
electronically, you must submit signed hardcopies of the required documentation no later than 4:30
PM on the closing date of the application period. If you are discharged/released later during the life of
the civil service list and otherwise qualify, you must submit this completed form and the required
documentation before points can be awarded.
You may be eligible for either ten points as a qualified disabled veteran or five points as a qualified
veteran (non disabled), but not both.
I am claiming ten (10) points as a qualified disabled veteran. Skip to part B: “Qualified
Disabled Veteran Criteria” on page 3; OR
I am claiming five (5) points as a qualified veteran (non disabled). Complete only part A below.
Revised 4-4-12
A. QUALIFIED VETERAN CRITERIA: You may claim five (5) veterans’ preference points if you
check at least one box below and provide proof of eligibility by submitting a copy of your DD-214
or DD-215 that includes your discharge/release status (e.g., honorable discharge).
I served on active duty* with the Armed Forces of the United States for a period of more
than 178 consecutive days and was discharged or released from active duty under
honorable conditions; OR
I served on active duty* with the Armed Forces of the United States for 178 days or less
and was discharged or released from active duty under honorable conditions because
of a service-connected disability; OR
I served on active duty* for at least one day in a combat zone and was discharged or
released from active duty under honorable conditions; OR
I received a combat or campaign ribbon for service in the Armed Forces of the United
States.
I am receiving a nonservice-connected pension from the United States Department of
Veterans Affairs.
*Attendance at a school under military orders, except schooling incident to an active enlistment
or regular tour of duty, or normal military training as a reserve officer or member of an
organized reserve or National Guard unit is not considered active duty.
***You must provide proof of eligibility by submitting a copy of your DD-214 or DD-215.
I hereby claim non-disabled veterans’ preference points 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.
Print Name:
Social Security No.:
-
-
Signature of Applicant: ___________________________________ Date:
Title of position applied for:
***Points will not be awarded without the appropriate documentation. You must submit
a copy of your DD-214 or DD-215 in all cases, even if you have previously submitted a
copy to the District. You will not receive points without accompanying documents.***
OAR 839-006-0465
_______________________________________________________________________________
Revised 4-4-12
B. QUALIFIED DISABLED VETERAN CRITERIA: You may claim ten (10) veteran’s
preference points if you can check at least one box below and provide proof of eligibility by
submitting both:
1.
a copy of your DD-214 or DD-215 form showing your discharge status, and
2.
a copy of your Veterans’ disability preference letter dated within the last 6 months
from the Department of Veteran’s Administration.
I have a disability rating from 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 disabled veteran’s preference points 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.
Print Name:
Social Security No.:
-
-
Signature of Applicant: ___________________________________ Date:
Title of position applied for:
***Points will not be awarded without the appropriate documentation. You must submit
a copy of your DD-214 or DD-215 that shows discharge status in all cases. If you are
claiming disabled veterans’ preference points, you must also submit a copy of your
veterans’ disability preference letter from the Department of Veteran’s Administration
dated within the last 6 months. You will not receive points without these accompanying
documents.***
OAR 839-006-0465
Revised 4-4-12

Download Veterans' Points Form - Scored Exam Positions - Oregon

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