EMPLOYMENT PREFERENCE FORM
Name
Position Applied For
Job Title Position No. Department Name
Employment preference allows applicants to claim a preference under the Veterans' Public Employment Preference Act
or the Persons with Disabilities Public Employment Preference Act. Applying for a preference is voluntary. All information
related to a preference will be kept confidential and used only during the hiring process. Applicants hired by the state will
have this information placed in a separate confidential selection file.
Contact your local Job Service Workforce Center for details on veterans' preference. Contact your local Montana
Vocational Rehabilitation Services Office, Department of Public Health and Human Services (DPHHS) for details on
obtaining persons with disabilities preference certification.
1. To claim Veterans' Employment Preference you must be a U.S. Citizen and (check one of the boxes below):
A Veteran, if
1. you were separated under honorable conditions, AND
you served more than 180 consecutive days of active federal military duty other than for training in the Army, Air
Force, Navy, Marines, or Coast Guard or were a member of the reserves who served on federal military duty
during a period of war or in a campaign or expedition for which a campaign badge is authorized.
2. You are or were a member of the Montana Army or Air National Guard who satisfactorily completed a minimum of 6
years service in armed forces, the last 3 of which have been served in the Montana Army or Air National Guard.
A Disabled Veteran, if
1. you were separated under honorable conditions from military duty, AND
2. you have an established Armed Forces service-connected disability OR are receiving compensation, disability
retirement benefits, or pension from the U.S. Department of Veterans Affairs or military department, OR you have
received a Purple Heart.
The spouse of a disabled veteran if the veteran's disability prevents him or her from working.
The unremarried surviving spouse of a veteran or disabled veteran.
The mother of a veteran, if
1. the veteran died under honorable conditions while serving in the Armed Forces, or the veteran has a service-
connected, permanent, and total disability, AND
2. your spouse is totally and permanently disabled, OR you are the unremarried widow of the father of the veteran.
2. To claim Montana Persons with Disabilities Employment Preference, you must be (check one of the boxes below):
A person with a disability certified by DPHHS, OR
The spouse of a totally (100%) disabled person certified by DPHHS AND have resided continuously in Montana for
at least 1 year immediately before applying for employment.
3. In the box below, check the attachment you have included to document your eligibility for employment
preference.
DD-214 showing the character of discharge Service-connected disability letter
DPHHS Disability Certification A document issued by the Office of the Adjutant General of
the Montana National Guard certifying service
SIGNATURE (typed or written): DATE SIGNED:
PD-25A (rev. 04/09) Online form available at: http://wsd.dli.mt.gov/service/app.asp (scroll down to State of Montana Employment
Application & Information).
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome