APPLICATION FOR VETERANS CREDIT
Answer every question. Print or type only. Credit cannot
be granted unless supported by discharge document.
DO NOT WRITE IN THIS SPACE
Veterans Credits
Disabled Veterans Credits
Anticipated Veterans Credits
APPROVED
+_____
DISAPPROVED
REASON
2. NUMBER AND TITLE OF EXAMINATION:
1. __________________________________________ ___________________________________________
LAST FIRST M.I.
STREET ADDRESS: __________________________
MAILING ADDRESS: _________________________
CITY: __________________ STATE: ____________
ZIP: ___________
3. LAST 4 DIGITS OF SOCIAL SECURITY NUMBER: 4. BIRTH DATE: _______________________________
XXX-XX-
5. SERVICE SERIAL NUMBER/S: 6. DATES OF ACTIVE SERVICE:
__________________________________________ FROM: _________________
TO: ___________________
7. CREDITS CLAIMED: (CHECK ONE) 8. PRESENT LEGAL RESIDENCE:
NON-DISABLED VETERAN STREET ADDRESS: ___________________________
MAILING ADDRESS: __________________________
DISABLED VETERAN CITY: ______________________ STATE: _________
ZIP: ___________
V.A. CLAIM NO.: __________________________
HAVE YOU SENT AUTHORIZATION FOR
DISABILITY RECORD TO V.A.?
YES (IF SO WHEN) ____________ NO
ANTICIPATED VETERAN
9. LIST ALL YOUR PUBLIC SERVICE EMPLOYMENT SINCE JANUARY 1, 1951:
DATES
FROM TO
EMPLOYER NAME AND ADDRESS
TITLE OF YOUR POSITION
VETERANS CREDITS USED
YES NO
SUBJECT TO THE PENALTIES OF PERJURY, I DECLARE THAT THE STATEMENTS MADE ON THIS FORM AND ANY
ATTACHMENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
SIGNATURE _____________________________________________ DATE: ___________________________
PAGE 2
May 20, 2010
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FULTON COUNTY PERSONNEL DEPARTMENT
FORT JOHNSTOWN BUILDING, 1 EAST MONTGOMERY STREET
JOHNSTOWN, NEW YORK, 12095-2534
TELEPHONE: 736-5574 FAX: 736-1027
APPLICATION FOR VETERANS CREDIT
APPLICANT: READ INSTRUCTIONS CAREFULLY
A. In order that your claim for additional credit as a Veteran can be processed, follow the instructions below. Failure to follow these
instructions completely may result in denial of Veterans Credits on the eligible list. Please give this your immediate attention since
Veterans Credit cannot be granted after the eligible list has been established.
Answer all questions on the reverse side of this form. Attach documentary proof of your eligibility, as specified under B or C
below and return to Fulton County Personnel Office at the above address.
IF APPLYING FOR DISABLED VETERANS CREDIT
Complete enclosed Authorization for Disability Record in duplicate and forward immediately to your Regional Veterans
Administration Office.
B.
VETERAN’S CREDIT ELIGIBILITY REQUIREMENTS
ACCEPTABLE DOCUMENTARY PROOF:
1.
Citizen of the United States
Report of Military Separation;
2.
Honorably discharged or released under honorable
circumstances from the Armed Forces of the United
States.
Report of Separation and Honorable Discharge and/or
Certificate of Service. Acceptable military forms
NAVPERS-553; NAVMC-78PD; WDAGO-53.55; WDAGO-
53.98: DD214. If your name is different from that shown
on your Report of Separation and Honorable Discharge
and/or Certificate of Service, include a marriage certificate
or other legal document to verify the change.
3.
Active duty in the Armed Forces of the United States
during any of the following periods:
Same as for requirement 2. above.
a. April 6, 1917 Nov 11, 1918
b. Dec 7, 1941 Dec 31, 1946
c. U.S. Public Health Service
July 29, 1945 Sept 2, 1945
June 26, 1950 July 3, 1952
d. June 27, 1950 Jan 31, 1955
e. Feb 28, 1961 May 7, 1975
f. June 1, 1983 Dec 1, 1987
g. Oct 23, 1983 Nov 21, 1983
h. Dec 20, 1989 Jan 31, 1990
i. Aug 2, 1990 the date upon
which such hostilities end.
For service under f, g or h:
Credit limited to those who received the armed forces
expeditionary medal, navy expeditionary medal, or marine
corps expeditionary medal. (The DD214 form must
indicate issuance of the medal.)
4.
If since January 1, 1951, you have used your additional credits as a disabled or non-disabled veteran for appointment
to any position in the public employment of New York State or its civil division, you may not claim them again.
C. ANTICIPATED VETERAN’S CREDIT ELIGIBILITY REQUIREMENTS
1. Proof of current military status Military ID card
Military orders
Official Military documents substantiating active
status at the time of exam.
NOTE: Any of the documents listed above, either the original or photocopy, will be considered as satisfactory evidence for each
requirement. All original documents will be returned after your claim has been processed.
PAGE 1
May 20, 2010
FULTON COUNTY PERSONNEL DEPARTMENT
FORT JOHNSTOWN BUILDING, 1 EAST MONTGOMERY STREET
JOHNSTOWN, NEW YORK, 12095-2534
TELEPHONE: 736-5574 FAX: 736-1027
TO:
FROM: Theresa Souza, Director of Personnel
DATE:
RE: Your Application for Examination _______________________________________
According to Civil Service Law, additional credit in examinations is granted to successful candidates who have claimed and
established status as disabled veterans, non-disabled veterans, or candidates currently in the armed forces. This credit is
granted on the following basis:
Open-Competitive Examinations Promotion Examinations
Disabled Veteran 10 05
Non-Disabled Veteran 05 2.5
The additional credit, which is added to the final passing score in the examination, may only be granted at the time of the
establishment of the eligible list. You will be allowed a period of not less than 2 months from the date you file your application
for examination to establish your eligibility by appropriate documentary proof to receive veteran’s, disabled veteran’s, or
anticipated veteran’s credits to qualify for credit in an examination.
CANDIDATES WHO CLAIM CREDIT, BUT WHO FAIL TO SUBMIT ADEQUATE PROOF OF ELIGIBILITY FOR SUCH CREDIT BY
THE TIME THE ELIGIBLE LIST IS ESTABLISHED, CANNOT LATER BE GRANTED CREDIT ON SUCH ELIGIBLE LIST.
ELIGIBLES GRANTED CONDITIONAL VETERAN’S CREDITS WILL BE RESTRICTED FROM CERTIFICATION USING THE
ADDITIONAL CREDITS UNTIL THE VETERAN PROVIDES PROOF OF HONORABLE DISCHARGE OR RELEASE AND THAT SUCH
SERVICE WAS IN TIME OF WAR.
ALL VETERANS
To be considered for additional credit as a veteran, the enclosed application for veterans credit must be completed and
returned to this office with a copy of your discharge or certificate of service from the armed forces of the United States
showing that you have served on active duty with the Armed Forces of the United States in time of war and that you were
honorably discharged or released under honorable circumstances from such service.
DISABLED VETERANS
In addition to the above, a disabled veteran must complete the enclosed Authorization for Disability Record in duplicate.
Forward both copies of the Authorization for Disability Record immediately to the Regional Office of the United States Veterans
Administration where your application for disability pension is on file.
To qualify for credit as a disabled veteran you must be receiving payments from the Veterans Administration for a war incurred
disability of at least 10%. The Veterans Administration must certify the disability to be in existence at the time of your
application for veterans credit.
ANTICIPATED VETERANS
To qualify for conditional veteran’s credits you must provide proof of current military status. However, to use such credit you
must later qualify as a Veteran or Disabled Veteran.
Your receipt of the enclosed forms does not mean that your application for the examination has been approved. These forms
are often mailed before applications have been reviewed.
If you have any questions concerning procedures regarding your claim, please write or phone this office. Include the number
and title of the examination in any letters of inquiry.
Enclosures: Application for Veterans Credits
Authorization for Disability Record (If Applicable) May 20, 2010