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Application For 10-Point Veterans Preference SF 15 - Official Federal Forms
| Application For 10-Point Veterans Preference Form. This is a national form and can be used in Standard US Office Of Personnel Management . |
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APPLICATION FOR 10-POINT VETERAN PREFERENCE (TO BE USED BY VETERANS & RELATIVES OF VETERANS) U.S. Office of Personnel Management Form Approved: O.M.B. No. 3206-0001 2. Name of Civil Service or Postal Service exam and/or job announcement number you have applied for or position which you currently occupy PERSON APPLYING FOR PREFERENCE 1. Name (Last, First, Middle) 3. Home address (Street Number, City, State and ZIP Code) 4. Date exam was held or application submitted VETERAN INFORMATION (to be provided by person applying for preference) 5. Veteran's name (Last, First, Middle) exactly as it appears on Service Records 7. Veteran's periods of service Branch of Service From To Service Number 6. VA claim number, if any TYPE OF 10-POINT PREFERENCE CLAIMED Instructions: Check the block which indicates the type of preference you are claiming. Answer all questions associated with that block. The Documentation Required column refers you to the back of this form for the documents you must submit to support your application. (Please Note: Eligibility for veterans' preference is governed by 5 U.S.C. 2108 and 5 CFR Part 211. All conditions are not fully described on this form because of space restrictions. You should submit this completed form to the agency to which you are applying. They can also provide any additional information.) Documentation Required (See reverse of this form.) 8. Veteran's Claim for Preference based on non-compensable service-connected disability; award of the Purple Heart; or receipt of disability pension under public laws administered by the VA. 9. Veteran's Claim for Preference based on eligibility for or receipt of compensation from the VA or disability retirement from a Service Department for a 10% or more service-connected disability. 10. Preference for a Spouse of a living veteran based on the fact that the veteran, because of a service-connected disability, has been unable to qualify for a Federal or D.C. Government job, or any other position along the lines of his/her usual occupation. (If your answer to item A is No, you are ineligible for preference and need not submit this form.) 11. Preference for a Widow or Widower of a veteran. (If your answer is No to item A or Yes to item B, you are ineligible for preference and need not submit this form). -- -- -- -- -- -- -- -- -- -- -- -- -- ---- -- -- -- -- -- -- -- -- -- -- -- -- -- -- ---- -- Yes a. Are you presently married to the veteran? No A and B A and C C and H a. Were you married to the veteran when he or she died? b. Have you ever remarried? Do not count marriages that were annulled. a. Are you married? A, D, E, and G (Submit G when applicable.) 12. Preference for (Natural) Mother of a service-connected permanently and totally disabled, or deceased veteran provided you are or were married to the father of the veteran, and --- your husband (either the veteran's father or the husband of a remarriage) is totally and permanently disabled, or --- you are now widowed, divorced, or separated from the veteran's father and have not remarried, or --- you are widowed or divorced from the veteran's father and have remarried, but are now widowed, divorced, or separated from the husband of your remarriage. (If your answer is No to item C or D, you are ineligible for preference and need not submit this form.) Disabled Veteran C, F, and H (Submit F when applicable.) b. Are you separated? If Yes, do not complete C, go to D. c. If married now, is your husband totally and permanently disabled? d. If the veteran is dead, did he/she die in active service? Deceased Veteran A, D, E, and F (Submit F when applicable.) PRIVACY ACT AND PUBLIC BURDEN STATEMENT The Veterans' Preference Act of 1944 authorizes the collection of this information. The information will be used, along with any accompanying documentation to determine whether you are entitled to 10-point veterans' preference. This information may be disclosed to: (1) the Department of Veterans Affairs, or the appropriate branch of the Armed Forces to verify your claim; (2) a court, or a Federal, State, or local agency for checking on law violations or for other related authorized purposes; (3) a Federal, State, or local government agency, if you are participating in a special employment assistance program; or (4) other Federal, State, or local government agencies, congressional offices, and international organizations for purposes of employment consideration, e.g., if you are on an Office of Personnel Management or other list of eligibles. Failure to provide any part of the information may result in a ruling that you are not eligible for 10-point veterans' preference or in delaying the processing of your application for employment. Public burden reporting for this collection of information is estimated to take approximately 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to OPM Forms Officer, U.S. Office of Personnel Management, Washington, D.C. 20415; The OMB Number, 3206-0001, is currently valid. OPM may not collect this information and you are not required to respond, unless this number is displayed. I certify that all of the statements made in this claim are true, complete, and correct to the best of my knowledge and belief and are made in good faith. (A false answer to any question may be grounds for not employing you, or for dismissing you after you begin work, and may be punishable by fine or imprisonment (U.S. Code, Title 18, Section 1001)). Preference entitlement was verified Name of Agency This form must be signed by all persons claiming 10-Point preference Signature of person claiming preference Date signed (Month, Day, Year) FOR USE BY APPOINTING OFFICER ONLY Signature of Appointing Officer Title of Appointing Officer Date signed (Month, Day, Year) Page 1 of 2 Standard Form 15 Revised August 2008 December 2004 edition usable; all other previous editions are unusable. American LegalNet, Inc. www.FormsWorkFlow.com DOCUMENTATION REQUIRED - READ CAREFULLY Please submit photocopies of documents because they will not be returned unless a certified copy is specified. A. Documentation of Service and Separation under Honorable Conditions Submit any of the documents listed bel
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