VETERANS’ PREFERENCE ELIGIBILITY FORM
Human Resources - Pinellas County Government
400 South Fort Harrison Ave, Room 418, County Annex Bldg, Clearwater, FL 33756-5113
(727) 464-3367
Florida Statutes Section 295.057 provides for Veterans’ Preference for eligible veterans and family members in employment
appointment, retention, reinstatement, reemployment, and promotion. Please note that preference will not be awarded retroactively.
SUBMISSION: If you seek Veterans’ Preference, please complete both sides of this form. Select the appropriate check box on side 2
and provide the required documents. Email the completed form and documentation to jobs@pinellascounty.org or mail the
information to the address listed above. The information must be received by the posted close date for the position. Once the
form is approved, it will be kept on file. You will not need to resubmit it for future positions.
IMPORTANT NOTICES:
In accordance with Florida law, preference in appointment, employment and promotion shall be given first to those persons included in
categories 1 and 2 and second to those persons included under categories 3, 4, 5, 6 and 7 (as shown on the next page). Preference in
appointment and employment requires that a preferred applicant be given special consideration in each step of the employment
selection process but does not require the employment of a preferred applicant over a non-preferred applicant who is more qualified for
the position.
If a qualified applicant claiming Veterans’ Preference for a vacant position is not selected, he/she may file a complaint with the Florida
Department of Veterans’ Affairs. A complaint must be filed within 21 days of the applicant receiving notice of the hiring decision made
by the employing agency or as otherwise provided in Rule 55A-7.016, Florida Administrative Code.
Submission of this form and accompanied documentation does not constitute automatic eligibility for Veterans’ Preference. Eligibility for
Veterans’ Preference is subject to verification of information and documentation provided.
The following positions are exempt from Veterans' Preference provisions:
Positions filled by officers elected by popular vote or persons
appointed to fill vacancies in such offices and personal secretary
of each such officer
Members of boards and commissions
Persons employed on a temporary basis without benefits
Heads of departments
Positions which require licensure such as a physician
Positions which require that the employee be a member
of The Florida Bar
PERSON APPLYING FOR PREFERENCE
Name (Last, First, Middle)
Email Address:
VETERAN INFORMATION (to be provided by the person applying for preference)
Veteran’s Name (Last, First, Middle - exactly as it appears on service records)
Branch of Service
Type of Discharge/Character of Service
Veteran’s periods of service
Date of Entry:
Date of Discharge:
Dates of Active Duty
From: To:
Dates of Training
From: To:
Does the veteran have a service connected disability? Yes No
If yes, is the service connected disability compensable? Yes No
What is the percentage of disability? %
Documentation you will be submitting for consideration for Veterans’ Preference:
WARTIME ERAS: For the purpose of determining Veterans' Preference, wartime era is limited to service during the following time
periods:
September 1, 2010 through present (Operation New Dawn)
March 19, 2003 through present (Operation Iraqi Freedom)
October 7, 2001 through present (Operation Enduring Freedom)
August 2, 1990 through January 2, 1992 (Persian Gulf War)
February 28, 1961 to May 7, 1975 (Vietnam Era)
June 27, 1950 to January 31, 1955 (Korea Conflict)
December 7, 1941 to December 31, 1946 (WWII)
April 6, 1917 to July 1, 1921, if one day of service was
between April 5, 1917 and November 12, 1918 (WWI)
April 6, 1917 to April 1, 1920, if served in Russia (WWI)
April 6, 1917 to November 11, 1918 (WWI)
www.pinellascounty.org/hr Revised 5/29/18
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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
(1)
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.
(2)
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.
(3)
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.
(4)
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.*
(5)
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.
(6)
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.
(7)
Required documents: A letter from Commanding Officer stating the dates of military service to establish service member is currently active.
Certification
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.
Name: Date
www.pinellascounty.org/hr Revised 5/29/18