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2. First Name*
3. Last Name*

5. Under Oregon law, some veterans who successfully complete all phases of a selection process for a posted vacant position with a public employer may be eligible for preference points on the list established as a result of the test. If you think you may qualify, please read the following checklist carefully. Check the box for each item that is appropriate. You may receive assistance from our office if you need further explanation or have special circumstances.

7. You may be eligible for either ten points as a qualified disabled veteran or five points as a qualified member or the Oregon National Guard, discharged or released from the Oregon National Guard under honorable conditions or veteran (non disabled), but not both.*

   1. I am claiming ten (10) points as a qualified disabled veteran. Skip to Part B: "Qualified Disabled Veteran Questions"; OR
   2. I am claiming five (5) points as a member of the Oregon National Guard, discharged or released from the Oregon National Guard under honorable conditions or qualified veteran (non disabled). Complete only Part A below.
11. A. QUALIFIED VETERAN QUESTIONS:

    You may claim five (5) veteran’s preference points if you check at least one box in the section below and provide proof of eligibility by submitting a copy of your DD-214 or DD-215 that includes your discharge/release status (e.g., honorable discharge), NGB Form 22 or a certification that you are a state servicemember of the Oregon National Guard.

13. ORS 408.237

    1. I am a member of the Oregon National Guard; OR
    2. I have been discharged or released from the Oregon National Guard under honorable conditions; OR
    3. I served on active duty* with the Armed Forces of the United States for a period of more than 178 consecutive days and was discharged or released from active duty under honorable conditions; OR
    4. I served on active duty* with the Armed Forces of the United States for 178 days or less and was discharged or released from active duty under honorable conditions because of a service-connected disability; OR
    5. I served on active duty* for at least one day in a combat zone and was discharged or released from active duty under honorable conditions; OR
    6. I received a combat or campaign ribbon for service in the Armed Forces of the United States; OR

15. *Attendance at a school under military orders, except schooling incident to an active enlistment or regular tour of duty, or normal military training as a reserve officer or member of an organized reserve or National Guard unit is not considered active duty.

17. ***You must provide proof of eligibility by submitting a copy of your DD-214 or DD-215, NGB Form 22, or a certification that you are a state servicemember of the Oregon National Guard.

    I hereby claim non-disabled veteran’s preference points and certify that the above information is true and correct. I understand that any false statements may be cause for my disqualification or dismissal, regardless of when discovered.

    Points will not be awarded without the appropriate documentation. You must submit a copy of your DD-214, DD-215, NGB Form 22, or a certification that you are a state servicemember of the Oregon National Guard in all cases, even if you have previously submitted a copy to the City of Forest Grove. You will not receive points without accompanying documents.

    ORS 408.210-235

19. First Name
20. Last Name
22. SSN:
24. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
26. Electronic Signature
27. Date:
    Date:
29. Title of position applied for:
33. B. QUALIFIED DISABLED VETERAN QUESTIONS:

    You may claim ten (10) veteran’s preference points if you can check at least one box in the section below and provide proof of eligibility by submitting both:

    1. a copy of your DD-214 or DD-215 form showing your discharge status, and
    2. a copy of your Veterans’ disability preference letter dated within the last 6 months from the Department of Veteran’s Administration.

    Points will not be awarded without the appropriate documentation. You must submit a copy of your DD-214 or DD-215 that shows discharge status in all cases. If you are claiming disabled Veteran points, you must also submit a copy of your Veterans’ disability preference letter from the Department of Veteran’s Administration dated within the last 6 months. You will not receive points without these accompanying documents.

    ORS 408.210-235

35. ORS 408.225(1)(b)

    1. I am entitled to disability compensation under laws administered by the United States Department of Veterans Affairs; OR
    2. I was discharged or released from active duty for a disability incurred or aggravated in the line of duty; OR
    3. I was awarded the Purple Heart for wounds received in combat.

37. I hereby claim disabled veteran’s preference points and certify that the above information is true and correct. I understand that any false statements may be cause for my disqualification or dismissal, regardless of when discovered.

39. First Name
40. Last Name
42. SSN:
44. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
46. Electronic Signature
47. Date:
    Date:
49. Title of position applied for:

51. After selecting "Print Only" Your completed application will open in a new browser tab. Your then able to save your completed form and include it with your application. The completed Veterans Preference Form should be added to the Supplemental Materials portion of the application. 

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