Veteran's Preference Points Application Form - City of Marshall, Minnesota

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VETERAN’S PREFERENCE
POINTS APPLICATION
Please return completed form to:
FOR OFFICE USE ONLY
City of Marshall Human Resources Office • 344 West Main Street • Marshall, MN 56258
Phone: 507/537-6790 • Fax: 507/537-6830 • E-mail:
Jobinformation@ci.marshall.mn.us
Date Received:
Website address:
www.ci.marshall.mn.us
You must submit a copy of your DD214—Member Copy 4 or other military documents to substantiate the service information requested on this
form. Claims not accompanied by proper documentation will not be processed. For assistance in obtaining military documents, contact the local
County Veterans’ Service Office at (507) 537-6729.
The City of Marshall operates under a point preference system, which awards points to qualified veterans to supplement their application. Points are awarded subject to the
provisions of MN Statute 43A.11. Ten (10) points are granted to non-disabled veterans on open competitive examinations; fifteen (15) points are awarded on open competitive
examinations if the veteran has a 10% or greater service connected compensable disability as certified by the U.S. Department of Veterans Affairs (USDVA).
Veteran’s Preference claims must be made on the form below and submitted with your application by the application deadline of the position for which you are applying. If the
DD214—Member Copy 4 or other supporting documentation is submitted to our office separate from this form, please attach a note with it indicating the position for which you are
applying and your present address.
Position you are applying for:
Name (Last)
(First)
(MI)
Are you a U.S. Citizen or Resident Alien?
Phone Number
 Yes
(
)
 No
Address (Street)
(City)
(State)
(Zip)
FOR OFFICE USE ONLY
5 points
10 points
15 points
Not approved
VETERAN—10 points
Member Copy 4 of DD214 or DD215 must be submitted to receive points
Honorably discharged veteran ………………………………………………  Yes
 No
DISABLED VETERAN—15 points on the passing score of an open competitive exam; 5 points on a promotional examination
rating for a first promotion only
Member Copy 4 of DD214 and USDVA letter of disability rating must be submitted to receive points
Honorably discharged veteran ………………………………………………  Yes
 No
Percent of Disability: _____%
 Yes
 No (entitled to 5 pts for first promotion only)
Have you ever been promoted in City of Marshall employment? ………
SPOUSE OF DECEASED VETERAN—10 points; 15 if the veteran was disabled at time of death
Member Copy 4 of DD214 or DD215, photocopy of marriage certificate, spouse’s death certificate and proof veteran died on or as a result
of active duty must be submitted to receive points. You are ineligible to receive points if you have remarried or were divorced from the
veteran.
 Yes
 No
Date of Death: _________
Have you remarried? ……………..
SPOUSE OF DISABLED VETERAN—15 points
Member Copy 4 of DD214 or DD215 and USDVA letter of disability rating decision must be submitted to receive points.
How does Veteran’s disability prevent performance of a stated job “requirement?” Due to the veteran’s service-connected disability the
veteran is unable to qualify for this position because (be specific):
AFFIDAVIT: I hereby claim Veterans’ Preference points for this examination and swear/affirm that the information given is true, complete
and correct to the best of my knowledge. I hereby acknowledge that I am responsible to obtain the required Veterans’ Preference
verification documents and submit them to the City of Marshall within 7 days of the application deadline.
Date:_______________________Signed:____________________________________________________________________________
Form 2014-10

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