PERSON APPLYING FOR PREFERENCE
Name (Last, First, Middle)
TYPE OF VETERANS’ PREFERENCE CLAIMED
Check the box below to indicate the type of preference you are claiming and answer all questions associated with that box. Submit this form and the
listed documentation by email to jobs@pinellascounty.org (or by mail to the address on side 1) to be received by the posted close date for the position.
CATEGORY/DOCUMENTATION REQUIRED
A disabled veteran who has served on active duty in any branch of the U.S. Armed Forces, has received an honorable discharge, and has
established the present existence of a service-connected disability that is compensable under public laws administered by the U.S.
Department of Veterans Affairs; or who is receiving compensation, disability retirement benefits, or pension by reason of public laws
administered by the U.S. Department of Veterans Affairs and U.S. Department of Defense.
Required documents: A Department of Defense document, commonly known as form DD-214 (Member 4 Copy recommended) or military
discharge papers, or equivalent certification from the DVA listing military status, dates of service and discharge type and a document from the
Department of Defense, the DVA, or the Department certifying that the veteran has a service-connected disability.
The spouse of a person who has a total disability, permanent in nature, resulting from a service-connected disability and who, because of this
disability, cannot qualify for employment; and the spouse of a person missing in action, captured in line of duty by a hostile force, or forcibly
detained or interned in line of duty by a foreign government or power.
Are you presently married to the veteran? Yes No
If No, have you remarried? Do not count marriages that were annulled. Yes No
Required documents:
Spouses of disabled veterans: A Department of Defense document, commonly known as form DD-214 (Member 4 Copy recommended) or
military discharge papers, or equivalent certification from the DVA, listing the spouse’s military status, dates of service and discharge type
and a certification from the Department of Defense or the VA that the veteran is totally and permanently disabled or an identification card
issued by the Department; and evidence of marriage to the veteran and a *statement that the spouse is still married to the veteran at the time
of the application for employment; and submit proof that the disabled veteran cannot qualify for employment because of the service-
connected disability.
Spouses of persons on active duty: A Department of Defense document or the DVA certifying that the person on active duty is listed as
missing in action, captured in line of duty, or forcibly detained or interned in line of duty by a foreign government or power; and evidence of
marriage and a statement that the spouse is married to the person on active duty at the time of application for employment.*
* Signing this form will serve as statement that you are still married to the veteran at the time of this application.
A wartime veteran as defined in s. 1.01(14), who has served at least one day during a wartime period. Active duty for training may not be
allowed for eligibility under this paragraph.
Required documents: A Department of Defense document, commonly known as form DD-214 (Member 4 Copy recommended) or military
discharge papers, or equivalent certification from the DVA, listing military status, dates of service and discharge type.
The unremarried widow or widower of a veteran who died of a service-connected disability.
Were you married to the veteran when he or she died? Yes No
Have you remarried since the veteran’s death? Do not count marriages that were annulled. Yes No
Required documents: A Department of Defense document or the DVA certifying the service-connected death of the veteran, and evidence
of marriage and a statement that the spouse is not remarried.*
*Signing this form will serve as statement that you (the spouse) has not remarried at the time of this application.
The mother, father, legal guardian, or unremarried widow or widower of a member of the U.S. Armed Forces who died in the line of duty
under combat-related conditions, as verified by the U.S. Department of Defense.
Relationship to service member: Mother Father Legal Guardian Unremarried widow/widower
Required documents: A Department of Defense document certifying the service-connected death of the veteran under combat-related
conditions. In addition, the legal guardian shall provide proper court documents establishing the legal authority of Guardianship.
A veteran as defined in s. 1.01(14). Active duty for training may not be allowed for eligibility under this paragraph.
Required documents: A Department of Defense document, commonly known as form DD-214 (Member 4 Copy recommended) or military
discharge papers, or equivalent certification from the DVA, listing military status, dates of service and discharge type.
A current member of any reserve component of the United States Armed Forces or the Florida National Guard.
Required documents: A letter from Commanding Officer stating the dates of military service to establish service member is currently active.
I acknowledge that I have read and understood the rights expressed in this notice. I certify that all information provided is
true, complete and correct to the best of my knowledge and belief, and is made in good faith.
www.pinellascounty.org/hr Revised 5/29/18
