Bainbridge Island Fire Department Veteran's Preference

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BAINBRIDGE ISLAND FIRE DEPARTMENT VETERAN’S PREFERENCE 8895 Madison Ave NE, Bainbridge Island, WA 98110 APPLICANT INFORMATION Last Name First Name Middle Name Jr., II, etc. E-Mail Address Military Service Number Primary Telephone Number Secondary Telephone Number MILITARY U.S. Military Branch of Service Date of Service Entrance Specialty Date of Service Separation Honorably Discharged Yes No Qualifying Service – Applicable period of war. Please check any/all periods of service or medals that apply: The Vietnam era, which means: (i) The period beginning on February 28, 1961, and ending on May 7, 1975, in the case of a veteran who served in the Republic of Vietnam during that period; (ii) The period beginning August 5, 1964, and ending on May 7, 1975 The following armed conflicts, if the participant was awarded the respective campaign badge: The crisis in Lebanon; the invasion of Grenada; Panama, Operation Just Cause; Somalia, Operation Restore Hope; Haiti, Operation Uphold Democracy; Bosnia, Operation Noble Eagle Operation Joint Endeavor, Nov 20, 1995 – Dec 19,1996 (Must have received the Armed Forces Expeditionary Medal) The Persian Gulf War, which was the period beginning August 2, 1990, and ending on January 2, 1992 Operation Enduring Freedom Operation Iraqi Freedom Global War on Terrorism Expeditionary Medal (Sept. 11, 2001 – Present), Afghanistan Campaign Medal, Iraq Campaign Medal Armed Forces Expeditionary Medal, or Marine Corps and Navy Expeditionary Medal, for opposed action on foreign soil, for service A Veteran who did not serve during a period of war or in an armed conflict as defined above. P UBLIC RECORD CIVIL COURT ACTIONS CERTIFICATION, AUTHORIZATION, AND RELEASE My statements on this form, and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that knowing and willful false statements on this form will result in immediate removal from the testing process and/or employment. Signature Date Submit your DD 214 or other supporting documents on the day of the written test with your other required documents. Any unsigned form or failure to submit supporting documents will cause your Veterans Preference to not be considered. January 2018 Page 1 of 1 .

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