ULSTER COUNTY PERSONNEL DEPARTMENT

County Office Building, 244 Fair Street, P.O. Box 1800,

Kingston, New York  12402-1800

APPLICATION FOR VETERANS CREDIT

__________________________________________________________________

Answer every question.  Print or type only.  Not valid unless accompanied by discharge document.

 

 

 

Do not write in This Space

 

 

 

Date

 

 

1

Conditional Veterans credits approved.

 

 

2

 

Veterans credits approved

 

 

3

 

Disabled Veteran

Credits approved

 

 

4

 

Credits recorded on eligible list

 

1. Number and Title of Examination 

 

3. Soc. Sec. No.

 

 

Birth Date

 

 

2. Mailing Address

 

Name _________________________________________________

 

Street _________________________________________________

 

City or                                                                        Zip

Post Office_____________________State_______ Code__________

 

4. Service Serial Number/s_______________

 

5. Dates of Active Service

 

FROM____________TO_____________

 

6. Residence on Date of Entry-Military Service

County

 

State

 

7.  Credits Claimed (Check One)

8. Present Legal Residence

 

Street ______________________________

 

City or

Post Office__________________________

 

State_______________________________

 

  □

 

Non-Disabled Veteran

□

 

Disabled Veteran

 

V.A. Claim No.____________________

Have you sent Authorization for

Disability Record to V.A.?

Yes

No

□

□

9. List ALL your public service employments since January 1, 1951

Dates

 

Veterans Credits Used

FROM

TO

Employer Name and Address

Title of Your Position

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Attach additional sheets if necessary)

10.  I declare, subject to the penalties of perjury, that the statements made on this form and any attachments are to the best of my knowledge true and correct.

 

Signature _________________________________________________ Date _____________________________

 

 

SEE INSTRUCTIONS ON BACK

 

UCP –VA707

 

 

ULSTER COUNTY PERSONNEL DEPARTMENT

County Office Building, 244 Fair Street, P.O. Box 1800, Kingston, New York  12402-1800

 

A.        In order that your claim for additional credit as a Veteran can be processed, follow the instructions checked in the boxes below.  Failure to follow these instructions completely may result in a restriction on the eligible list.  Please give this your immediate attention since Veterans Credit can not be granted after the eligible list has been established.

 

□       1.         Answer all questions on the reverse side of this form, attach documentary proof of your eligibility, as

                        Specified under B below and mail to the Ulster County Personnel Department.

 

□       2.         Complete enclosed authorization for disability record in duplicate, and forward immediately to your

                        Regional Veterans Administration Office.

 

B.

ELIGIBILITY REQUIREMENTS

ACCEPTABLE DOCUMENTARY PROOF

1. Citizen of the United States or an alien lawfully admitted for permanent residence.

 

2. Honorably discharged or separated from the Armed Forces of the United States.

 

 

 

 

 

 

3. Active duty in the Armed Forces of the United States during any of the following periods:

A.  December 7, 1941 to December 31, 1946

B.  June 27, 1950 to January 31, 1955

C.  December 22, 1961 to May 7, 1975

D.  August 2, 1990 to “date to be determined”

E.  U.S. Public Health Service:  July 29, 1945 to December 31, 1946, or June 27, 1950 to July 3, 1952

 

Possession of an expeditionary medal for any of the following conflicts:

F.  Lebanon – June 1, 1983 to December 1, 1987

G.  Grenada – October 23, 1983 to November 21, 1983

H.  Panama – December 20, 1989 to January 31, 1990

 

4. Residents of New York State at the time applying for Veterans Credits

 

5. If since January 1, 1951, you used your veterans credits for permanent appointment or promotion in New York State or its civil divisions, you may not claim them again.

Report of Military Separation;

 

 

Report of Separation and Honorable Discharge and/or Certificate of Service. Acceptable military forms NAVPERS-553; NAVMC-78 PD; WDAGO-53, 55; WDAGO-53, 98; DD 214. If your name is different from that shown on your Report of Separation and Honorable Discharge and/or Certificate of Service, include a marriage certificate or other legal document to verify the change.

 

Same as requirement 2, above.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This information will be secured by us from your application on file for this examination.

 

NOTE 1:  Please submit photocopies of any and all documentary proof as described above. Please do not submit originals. Documentary proof will not be returned.

 

NOTE 2:  □ Please check the box to the left if you are currently in the Armed Forces (other than for training purposes) and wish to apply for conditional veterans credits. In order to grant conditional veterans credit, you must, submit by the time of examination, acceptable proof such as a Military I.D. Card, Military Orders, or other official military documents that substantiate active military service. Upon separation from the Armed Forces it is your responsibility to notify the Ulster County Personnel Department and provide, as detailed in the chart above listing acceptable documentary proof, that service was in Time of War and that your discharge was Honorable or Under Honorable Circumstances.