Veterans' Preference Form - City of Barnum, Minnesota

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VETERANS’ PREFERENCE
COMPLETE THIS FORM ONLY IF YOU ARE CLAIMING VETERANS’ PREFERENCE NOTE: COPY OF “MEMBER
COPY 4” VETERAN’S DD214 MUST BE ATTACHED (Veteran is defined by Minn. Stat. § 197.447)
You must submit a PHOTOCOPY of your “Member Copy 4” of your
the full period called or ordered for federal, active duty and be a United
DD214 or other military documents to substantiate the service
States citizen or resident alien. Veteran’s preference may be used by
information requested on the form. Claims not accompanied by
the surviving spouse of a deceased veteran, who died on active duty or
proper documentation will not be processed. For assistance in
as a result of active duty, and by the spouse of a disabled veteran who is
obtaining a copy of your “member Copy 4” of your DD214, contact
unable to qualify because of the disability.
your County Veterans’ Service Office.
The City of Barnum operates under a point preference system, which
To qualify for preference on a promotional exam, a veteran must have
earned a passing exam score and received a USDVA active duty service
awards points to qualified veterans to supplement their application.
connected disability rating of 50% or more. For a promotional exam, a
Ten (10) points are granted to non-disabled veterans on open
qualified disabled veteran is entitled to be granted five ( 5) points.
competitive examinations; Fifteen (15) points are awarded if the
Disabled veterans eligible for such preference may use the five points
veteran has a service connected compensable disability as certified by
preference only for the first promotion after securing employment with
the U.S. Department of Veterans Affairs (USDVA).
the City of Barnum.
To qualify for preference for a competitive exam, you must have
Claims must be made on the form below and submitted with your
earned a passing score and been separated under honorable
application by the application deadline of the position for which you are
conditions from any branch of the armed forces of the United States
applying. If the “Member Copy 4” DD214 is submitted to our office
after having served on active duty for 181 consecutive days, or by
separate from this sheet, please attach a note with it indicating the
reason of disability incurred while serving on active duty, or after
position for which you are applying and your present address.
having served
Name (Last)
(First)
(MI)
Social Security Number
Position For Which You Applied
Closing Date:
Address (Street)
(City)
(State)
(Zip)
Phone Number
Are you a US Citizen or Resident Alien?
YES
NO
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):
(“Member Copy 4” of DD214 and USDVA letter of disability rating decision of 10% or more must be submitted to receive points)
Percent of Disability:
_____%
Have you ever been promoted within the City of _______ employment?
Yes
No
SPOUSE OF DECEASED VETERAN (10 points or 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.)
Date of Death: _________
Have you remarried?
Yes
No
SPOUSE OF DISABLED VETERAN (15 points):
(“Member Copy 4” of DD214 or DD215 and USDVA letter of disability rating decision of 10% or more 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 Barnum by the required application deadline.
_____________________________________________
___________________________
Signature
Date

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