Full Text
Form MSD 332VC1 Answer Every Question. Type or write with ink. Not valid unless notarized and accompanied by copy of DD214 CORTLAND COUNTY PERSONNEL/CIVIL SERVICE 60 Central Avenue – County Office Building Cortland, New York 13045 APPLICATION FOR VETERAN’S CREDITS Do Not Write In This Space Date By 1.Veteran credits approved. 2. Disabled Vet- eran credits approved 3. Credits Record- ed on applica- tion ( ) Disabled Veterans 1. Claim is hereby submitted for ( ) Non-Disabled Veterans credits on the examination To be 2. Print Full First Middle Last 3. Present Street City State 4. Are you a citizen of the United States? RESIDENCE 5. Home address at time of entry into military: No. Street City State 6. Home address at time of separation: No. Street City State 7. Home address for one year prior to date of this application: No. Street City State 8. Legal residence for three years prior to entrance into military service: Dates Place to to to to U.S. MILITARY SERVICE * 9. Indicate by in which you served ( ) Army; ( ) Navy; ( ) Marine Corps; ( ) Coast Guard; ( ) Air Force 10. Date of enlistment or induction of enlistment or induction 11. Dates of active service: From to Service Serial No. 12. Last Rank Attached to 13. Were you discharged or (released to inactive duty) under honorable conditions? Reason for discharge or release to inactive duty, as stated on 14. Date of discharge end of terminal leave Place of As indicated in your discharge or Certificate of Service (OVER) ---PAGE BREAK--- DISABLED VETERANS CREDITS (To be completed only by applicant claiming disabled veteran’s credits) 15. Veterans Administration Claim No. 16. Have you claimed additional credits as a Disabled Veteran in any previous examination given by this Civil Service Commission? Yes No 17. If answer to Item 16 is “Yes”, give title and date of examination. 18. Date accompany Form MSD333 VC-3 “Authorization For Disability Record” was sent to Veterans Administration TO BE SWORN TO BEFORE A NOTARY PUBLIC OR COMMISSIONER OF DEEDS I hereby certify that the foregoing statements are full and true to the best of my knowledge and belief. Applicant’s Sworn to before me day of Notary Public or Commissioner of Deeds Revised 2/08