Standard Form 15 - Application For 10-Point Veteran Preference Page 2
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2DOCUMENTATION REQUIRED - READ CAREFULLY
(PLEASE SUBMIT PHOTOCOPIES OF DOCUMENTS BECAUSE THEY WILL NOT BE RETURNED)
A.
DOCUMENTATION
OF
SERVICE
AND
SEPARATION
UNDER
3. An official statement or retirement orders from a branch of the Armed
Forces, showing that the retired serviceman was retired because of
HONORABLE CONDITIONS
permanent service-connected disability or was transferred to the permanent
disability retirement list. The statement or retirement orders must indicate
Submit any of the documents listed below as documentation, provided that they
that the disability is 10% or more.
are dated on or after the day of separation from active duty military service:
1. Honorable or general discharge certificates
For spouses and mothers of disabled veterans checking items 12 or 14, submit the
2. Certificate of transfer to Navy Fleet Reserve, Marine Corps Fleet Reserve,
following:
or enlisted Reserve Corps.
An official statement, dated within the last 12 months, from the Department of
3. Orders of Transfer to Retired List
Veterans Affairs or from a branch of the Armed Forces, certifying: 1) the
4. Report of Separation from a branch of the Armed Forces
present existence of the veterans service-connected disability, 2) the percentage
5. Certificate of Service or release from active duty, provided honorable
and nature of the service-connected disability or disabilities (including the
separation took place.
6. Official Statement from a branch of the Armed Forces showing that
combined percentage), 3) a notation as to whether or not the veteran is currently
honorable separation took place.
rated as "unemployable" due to the service-connected disability, and 4) a
notation as to whether or not the service-connected disability is rated as
7. Notation by the Department of Veterans Affairs or a branch of the Armed
permanent and total.
Forces on an official statement, described in B or C below, that the veteran
was honorably separated from military service.
D.
DOCUMENTATION OF VETERAN’S DEATH
8. Official statement from the Military Personnel Records Center that official
service records show that honorable separation took place.
1. If on active military duty at time of death, submit official notice, from a
B.
DOCUMENTATION OF SERVICE-CONNECTED DISABILITY (NON-
branch of the Armed Forces, of death occurring under honorable conditions.
2. If death occurred while not on active military duty, submit death certificate.
COMPENSABLE, I.E., LESS THAN 10%); PURPLE HEART; AND NON-
SERVICE-CONNECTED DISABILITY PENSION
E.
DOCUMENTATION OF SERVICE OR DEATH DURING A WAR, IN A
CAMPAIGN OR EXPEDITION FOR WHICH A CAMPAIGN BADGE IS
Submit one of the following documents if you checked item 11 on the front of this
AUTHORIZED, OR DURING THE PERIOD OF APRIL 28, 1952,
form:
THROUGH JULY 1, 1955
1. An official statement, dated within the last 12 months, from the Department
Submit documentation of service or death during a war or during the period
of Veterans Affairs or from a branch of the Armed Forces, certifying to the
April 28, 1952, through July 1, 1955, or during a campaign or expedition for
present existence of the veteran’s service-connected disability of less than
which a campaign badge is authorized.
10%.
2. An official citation, document, or discharge certificate, issued by a branch
of the Armed Forces, showing the award to the veteran of the Purple Heart
F.
DOCUMENTATION OF DECEASED OR DISABLED VETERAN’S
for wound or injuries received in action.
MOTHER’S CLAIM FOR PREFERENCE BECAUSE OF HER HUSBAND’S
TOTAL AND PERMANENT DISABILITY
3. An official statement, dated within the last 12 months, from the Department
of Veterans Affairs, certifying that the veteran is receiving a nonservice-
Submit a statement from Husband’s Physician showing the prognosis of his
connected disability pension.
disease and percentage of his disability.
C.
DOCUMENTATION OF SERVICE-CONNECTED DISABILITY
(COMPENSABLE, I.E., 10% OR MORE)
G.
DOCUMENTATION OF ANNULMENT OF REMARRIAGE BY WIDOW OR
WIDOWER OF VETERAN
Submit one of the following documents if you checked item 11 on the front of
Submit either:
this form:
1. Certification from the Department of Veterans Affairs that entitlement to
1. An official statement, dated within the last 12 months, from the Department
pension or compensation was restored due to annulment.
of Veterans Affairs or from a branch of the Armed Forces, certifying to the
veteran’s present receipt of compensation for service-connected disability
2. A certified copy of the court decree of annulment.
or disability retired pay.
H.
DOCUMENTATION OF VETERAN’S INABILITY TO WORK BECAUSE OF
2. An official statement, dated within the last 12 months, from the Department
A SERVICE-CONNECTED DISABILITY
of Veterans Affairs or from a branch of the Armed Forces, certifying that
Answer Questions 1-7 below:
the veteran has a service-connected disability of 10% or more.
1. IS THE VETERAN CURENTLY WORKING?
2. IF CURRENTLY WORKING, WHAT IS THE VETERAN’S PRESENT OCCUPATION?
(If "NO," go to item 3.)
YES
NO
3. WHAT WAS THE VETERAN’S OCCUPATION, IF ANY, BEFORE MILITARY SERVICE?
4. WHAT WAS THE VETERAN’S MILITARY OCCUPATION AT THE TIME OF SEPARTION?
5. HAS THE VETERAN BEEN EMPLOYED, OR IS
A. TITLE AND GRADE OF POSITION MOST RECENTLY, OR CURRENTLY HELD
C. DATES OF EMPLOYMENT
HE/SHE NOW EMPLOYED, BY THE FEDERAL
FROM
TO
CIVIL SERVICE OR D.C. GOVERNMENT?
B. NAME AND ADDRESS OF AGENCY
YES
NO
6. HAS THE VETERAN RESIGNED FROM, BEEN DISQUALIFIED FOR, OR SEPARATED FROM A POSITION IN THE
7. IS THE VETERAN RECEIVING A CIVIL SERVICE RETIREMENT PENSION?
FEDERAL CIVIL SERVICE OR D.C. GOVERNMENT ALONG THE LINES OF HIS/HER USUAL OCCUPATION BECAUSE
(If "YES," give the Civil Service or Federal Employee retirement annuity number)
OF SERVICE-CONNECTED DISABILITY?(If "YES," submit documentation of the resignation, disqualification, or separation.)
CSA
No.
NO
YES
NO
YES
EXCEPTION TO SF 15, APPROVED SEP 1999
STANDARD FORM 15 (REV. 2/90)
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