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For individuals seeking employment within the vast network of the Veterans Affairs (VA) healthcare system, the VA 10-2850c form serves as a critical step in the hiring process. This document is specifically designed for those applying for positions such as physicians, dentists, nurses, and other healthcare professionals, aiming to ensure that candidates meet the stringent standards required to provide care to veterans. Completing the VA 10-2850c form requires attention to detail and a thorough understanding of one’s own professional history, as it covers a wide range of information including personal details, education, licensure, experience, and prior affiliations. Its importance cannot be overstated, as it not only assesses qualifications but also helps in the identification of the best possible candidates who can contribute to the healthcare of those who have served. Navigating the complexities of this form can be daunting, yet it is a necessary step towards securing a position within the VA, a role that comes with the honor of serving the nation’s heroes.

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Approved Exception To SF 171 OMB No. 2900-0205 Estimated burden: 30 minutes

APPLICATION FOR ASSOCIATED HEALTH OCCUPATIONS

SEE LAST PAGE FOR PAPERWORK REDUCTION ACT, PRIVACY ACT AND INFORMATION ABOUT DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER.

INSTRUCTIONS: Please submit this application furnishing all information in sufficient detail to enable the Department of Veterans Affairs to

determine your eligibility for appointment in Veterans Health Administration.

Type, or print in ink. If additional space is required, please attach a separate sheet and refer to items being answered by number.

1.OCCUPATION FOR WHICH APPLYING

A

B

C D

CERTIFIED RESPIRATORY THERAPY TECHNICIAN

E

REGISTERED RESPIRATORY THERAPIST

F

LICENSED PHYSICAL THERAPIST

G

LICENSED PRACTICAL/VOCATIONAL NURSE

H

LICENSED PHARMACIST

PHYSICIAN ASSISTANT EXPANDED-FUNCTION DENTAL AUXILIARY OCCUPATIONAL THERAPIST

OTHER (Specify)

2. NAME (Last, First, Middle)

 

 

 

 

3. APPLICATION FOR (Check one)

 

 

 

 

 

 

 

GENERAL PRACTICE

SPECIALTY (Identify Below)

 

 

 

 

 

 

 

 

 

4. PRESENT ADDRESS (Include ZIP Code)

STREET ADDRESS 2

 

APT. NO.

 

5. TELEPHONE NUMBER (Include Area Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5A. RESlDENCE

5B. BUSINESS

CITY

 

 

 

STATE ZIP CODE

COUNTRY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. DATE OF BIRTH

7. PLACE OF BIRTH (City)

STATE

COUNTRY

 

8. SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

9A. CITIZENSHIP

 

 

 

 

 

 

 

 

9B. COUNTRY OF WHICH YOU ARE A CITIZEN

U.S. CITIZEN BY BIRTH

NATURALIZED U.S. CITIZEN

NOT A U.S. CITIZEN (Complete item 9B)

 

 

 

 

 

 

 

 

 

10A. HAVE YOU EVER FILED APPLICATION FOR APPOINTMENT IN THE VA

10B. NAME OF OFFICE WHERE FILED

 

10C. DATE FILED

YES

NO

(If "YES" complete items 10B and 10C)

 

 

 

 

 

 

 

 

 

 

 

 

 

11. WHEN MAY INQUIRY BE MADE OF YOUR PRESENT EMPLOYER

 

12. DATE AVAILABLE FOR EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I - ACTIVE MILITARY DUTY

 

 

 

 

13A. DATE FROM

 

13B. DATE TO

13C. SERIAL OR SERVICE NO. 13D. BRANCH OF SERVICE

 

13E. TYPE OF DISCHARGE

 

 

 

 

 

 

 

 

 

HONORABLE

 

OTHER (Explain on

 

 

 

 

 

 

 

 

 

 

 

separate sheet)

II - LICENSURE, DEA CERTIFICATION, REGISTRATION AND CLINICAL PRIVILEGES (As applicable)

14A. LIST ALL STATES/TERRITORIES IN WHICH

 

14C. CURRENT REGISTRATION

 

YOU ARE NOW OR HAVE EVER BEEN LICENSED

14B. LICENSE NO.

(If "NO" explain on separate sheet)

14D. EXPIRATION DATE

(If not held now, explain on separate sheet)

 

YES

NO

NOT REQUIRED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15A. ARE YOU FULLY LICENSED IN EVERY STATE

15B. DO YOU HAVE PENDING OR HAVE YOU EVER HAD A

15C. HAVE YOU EVER HELD A

IN WHICH YOU RECEIVED A LICENSE

STATE LICENSE TO PRACTICE REVOKED, SUSPENDED,

REGISTRATION TO PRACTICE THAT IS

(If restricted, limited or probational in any State(s),

DENIED, RESTRICTED, LIMITED, OR ISSUED/PLACED ON A

NO LONGER HELD OR CURRENT

explain on separate sheet)

 

PROBATIONAL STATUS OR VOLUNTARILY RELINQUISHED

 

(If "YES" explain on

 

 

 

 

 

 

 

YES

NO

NOT APPLICABLE

YES

NO

(If "YES" explain on separate sheet)

YES

NO separate sheet)

16A. NAME THE CERTIFYING BODY FOR YOUR HEALTH OCCUPATION

16B. DATE OF MOST RECENT REGISTRATION/CERTIFICATION (Give Month and Year)

16C. WHAT IS YOUR REGISTRY/ CERTIFICATION NUMBER

16D. HAS ACTION EVER BEEN TAKEN AGAINST YOUR CERTIFICATION OR REGISTRATION

YES

NO (If "YES" explain on

 

separate sheet)

17A. DO YOU CURRENTLY HAVE OR HAVE YOU EVER

HAD CLINICAL PRIVILEGES AT ANY HEALTH CARE INSTITUTION, AGENCY OR ORGANIZATION

YES

NO (If "YES" complete Item 17B)

17B. NAME OF CURRENT OR MOST RECENT INSTITUTION, AGENCY OR ORGANIZATION WHERE HELD

17C. HAVE ANY OF YOUR STAFF APPOINTMENTS OR

CLINICAL PRIVILEGES EVER BEEN DENIED, REVOKED, SUSPENDED, REDUCED, LIMITED, OR VOLUNTARILY RELINQUISHED

YES

NO (If "YES" explain on

 

separate sheet)

III - THIS SECTION TO BE COMPLETED BY FACILITY DIRECTOR OR DESIGNEE

CERTIFICATION: I certify that I have verified licensure and registration with State boards, and cited visa or evidence of citizenship. Board certification has been verified (if appropriate).

 

18. EVIDENCE HAS BEEN CITED IN REGARDS TO:

 

 

 

 

 

 

 

CERTIFICATION OR REGISTRATION

 

 

 

VISA

 

 

 

 

 

 

 

 

 

 

 

NATURALIZED CITIZENSHIP

 

 

 

CURRENT OR MOST RECENT CLINICAL PRIVILEGES

 

 

 

 

 

 

 

 

 

 

 

LICENSURE/REGISTRATION FOR ALL STATES LISTED BY APPLICANT

 

NO CURRENT OR PREVIOUS CLINICAL PRIVILEGES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19A. SIGNATURE OF AUTHORIZED OFFICIAL

 

19B. TITLE

 

 

19C. DATE (MONTH, DAY, YEAR)

 

 

 

 

 

 

 

 

 

 

 

VA FORM

10-2850c

EXISTING STOCK OF VA FORM 10-2850c, JUN 2006, WILL BE USED.

PAGE 1

NOV 2016 (R)

IV - LIABILITY INSURANCE (As applicable)

20A. PRESENT LIABILITY

20B. DATE COVERAGE 20C. NAMES OF PRIOR CARRIERS 20D. DATE OF COVERAGE

21. HAS ANY CARRIER EVER

INSURANCE CARRIER

BEGAN

 

 

CANCELLED, DENIED OR

FROM

TO

 

 

REFUSED TO RENEW YOUR

 

 

 

 

 

 

 

 

INSURANCE

 

 

 

 

 

YES

NO

(If "YES" explain on separate sheet)

V - QUALIFICATIONS

BASIC ALLIED HEALTH EDUCATION (Continue on separate sheet, if necessary)

22A. NAME OF SCHOOL

22B. ADDRESS (City, State and ZIP Code)

22C. LENGTH OF

22D. DATE

PROGRAM

COMPLETED

 

 

22E. DIPLOMA OR

DEGREE RECEIVED

ADDITIONAL EDUCATION (Continue on separate sheet, if necessary)

23A. NAME OF SCHOOL

23B. ADDRESS (City, State and ZIP Code)

23C. MAJOR

23D. DATE

COMPLETED

23E. 23F.

CREDITS DEGREE

Vl - PROFESSIONAL EXPERIENCE

24A. EMPLOYER

24B. ADDRESS (City, State and ZIP Code)

24C. POSITION (Where applicable, also specify whether General Practitioner or Specialist)

26D.

FULL-

TIME

26E. PART-TIME

AVERAGE HOURS

PER WEEK

26F. DATES EMPLOYED

FROM

TO

 

 

Vll - GENERAL INFORMATION

25. NAMES UNDER WHICH YOU WERE EMPLOYED, IF DIFFERENT FROM NAME GIVEN IN ITEM 1.

26. LIST ALL PUBLICATIONS, SCIENTIFIC PAPERS, HONORS, AWARDS, RESEARCH GRANTS, FELLOWSHIPS (If additional space is required, attach separate sheet).

VlIl - REFERENCES

27.REFERENCES: List at least four persons living in the United States who are not related to you by blood or marriage and who have been in a position to judge your qualifications during the past five years.

27A. NAME

27B. ADDRESS (Number, Street, City, State and ZIP Code)

27C. AREA CODE/PHONE NO.

27D. BUSINESS OR OCCUPATION

VA FORM

10-2850c

PAGE 2

NOV 2016 (R)

REFERENCES (Continued)

27A. NAME

 

27B. ADDRESS (Number, Street, City, State and ZIP Code)

27C. AREA CODE/PHONE NO.

27D. BUSINESS OR OCCUPATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM NO.

PLACE AN "X" IN APPROPRIATE SPACE. IF "YES" EXPLAIN DETAILS ON SEPARATE SHEET

YES

NO

28.Do you receive or do you have a pending application for retirement or retainer pay, pension, or other compensation based upon military, Federal civilian, or District of Columbia service?

29.Does the Department of Veterans Affairs employ any relative of yours (by blood or marriage)? If "YES" give separately such relative's (1) full name; (2) relationship; (3) VA position and employment location.

 

ARE YOU NOW, OR HAVE YOU EVER BEEN, INVOLVED IN ADMINISTRATIVE OR JUDICIAL PROCEEDINGS

 

IN WHICH MALPRACTICE ON YOUR PART IS OR WAS ALLEGED? (If "YES" give details including name of action or

 

proceedings, date filed, court or reviewing agency, and the status or disposition of case concerning allegations, together with

30.

your explanation of the circumstances involved.)

 

(As a provider of health care services, the VA has an obligation to exercise reasonable care in determining that applicants are

 

properly qualified. It is recognized that many allegations of malpractice are proven groundless. Any conclusion concerning

 

your answer as it relates to your qualifications will be made only after a full evaluation of the circumstances involved.)

NOTE: A conviction or a discharge does not necessarily mean you cannot be appointed. The nature of the conviction or discharge and how long ago it

occurred is important. Give all the facts so that a decision can be made. If your answer to question 33, 34 or 35 is "YES" give for each offense: (1) date;

(2)charge; (3) place; (4) court and (5) action taken. When answering item 33 or 34, you may omit (1) traffic fines for which you paid a fine of $100.00 or less; (2) any offense committed before your 18th birthday which was finally adjudicated in a juvenile court or under a youth offender law; (3) any conviction the record of which has been expunged under Federal or State law; and (4) any conviction set aside under the Federal Youth Corrections Act or similar State authority.

31.

Within the last five years have you been discharged from any position for any reason?

32.Within the last five years have you resigned or retired from a position after being notified you would be disciplined or discharged, or after questions about your clinical competence were raised?

Have you ever been convicted, forfeited collateral, or are you now under charges for any felony or any firearms or explosives

33.offense against the law? (A felony is defined as any offense punishable by imprisonment for a term exceeding one year, but does not include any offense classified as a misdemeanor under the laws of a State and punishable by a term of imprisonment of two years or less.)

34.During the past seven years have you been convicted, imprisoned, on probation or parole, or forfeited collateral, or are you now under charges for any offense against the law not included in 33 above?

35.

While in the military service were you ever convicted by a general court-martial?

36.If you were in the military service in one of these health occupations, did you ever receive a non-judicial punishment (Article 15)?

Are you delinquent on any Federal debt? (Include delinquencies arising from Federal taxes, loans, overpayment of benefits, and other debts to the U.S. Government, plus defaults on any Federally guaranteed or insured loans such as student and home mortgage loans.)

37.If "Yes" explain on a separate sheet the type, length, and amount of the delinquency or default and steps you are taking to correct errors or repay the debt. Give any identification numbers associated with the debt and the address of the Federal agency involved.

IX - SIGNATURE OF APPLICANT

NOTE: A false statement on any part of your application may be grounds for not hiring you, or for terminating you after you begin work. Also, you may be punished by fine or imprisonment (U.S. Code, Title 18, Section 1001).

CERTIFICATION: I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL OF MY STATEMENTS ARE TRUE, CORRECT, COMPLETE, AND MADE IN GOOD FAITH.

38A. SIGNATURE OF APPLICANT

38B. DATE (Month, Day,Year)

VA FORM

10-2850c

PAGE 3

NOV 2016 (R)

AUTHORIZATION FOR RELEASE OF INFORMATION

In order for the Department of Veterans Affairs (VA) to assess and verify my educational background, professional qualifications and suitability for employment, I:

Authorize VA to make inquiries concerning such information about me to my previous employer(s), current employer, educational institutions, State Medical Boards, other professional organizations and/or persons, agencies, organizations or institutions listed by me as references, and to State licensing boards, professional liability insurance carriers, national practitioner data bank, American Medical Association, Federation of any other appropriate sources to whom VA may be referred by those contacted or deemed appropriate;

Authorize release of such information and copies of related records and/or documents to VA officials;

Release from liability all those who provide information to VA in good faith and without malice in response to such inquiries; and

Authorize VA to disclose to such persons, employers, institutions, boards or agencies identifying and other information about me to enable VA to make such inquiries.

SIGNATURE

DATE

PAPERWORK REDUCTION ACT AND PRIVACY ACT NOTICE

The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 30 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form.

AUTHORITY: The information requested on the attached application form and Authorization for Release of Information is solicited under Title 38, United States Code, Chapters 73 and 74.

PURPOSES AND USES: The information requested on the application is collected primarily to determine your qualifications and suitability for employment. If you are employed by the VA, the information will be used to make pay and benefit determinations and, as necessary, in personnel administration processes carried out in accordance with established regulations and the published notice of the system of records "Applicants for Employment under Title 38, U.S.C.-VA" (02VA135)

ROUTINE USES: Information on the form or the form itself may be released without your prior consent outside the VA to another Federal, State or local agency, to the National Practitioner Data Bank which is administered by the Department of Health and Human Services, to State licensing boards, and/or appropriate professional organizations or agencies to assist the VA in determining your suitability for hiring and for employment, to periodically verify, evaluate and update your clinical privileges and licensure status, to report apparent or potential violations of law, to provide statistical data upon proper request, or to provide information to a Congressional office in response to an inquiry made at your request. Such information may also be released without your prior consent to Federal agencies, State licensing boards, or similar boards or entities, in connection with the VA's reporting of information concerning your separation or resignation as a professional staff member under circumstances which raise serious concerns about your professional competence. Information concerning payments related to malpractice claims and adverse actions which affect clinical privileges also may be released to State licensing boards and the National Practitioner Data Bank. The information you supply may be verified through a computer matching program at any time.

EFFECTS OF NON-DISCLOSURE: See statement below concerning disclosure of your social security number. Disclosure of the other information is voluntary; however, failure to provide this information may delay or make impossible the proper application of Civil Service rules and regulations and VA personnel policies and thus may prevent you from obtaining employment, employees benefits, or other entitlements.

INFORMATION REGARDING DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER UNDER PUBLIC LAW 93-579 SECTION 7(b)

Disclosure of your SSN (social security number) is mandatory to obtain the employment and related benefits that you are seeking. Solicitation of the SSN is authorized under the provisions of Executive Order 9397, dated November 22, 1943. The SSN is used as an identifier throughout your Federal career from the time of application through retirement. It will be used primarily to identify your records. The SSN also will be used by Federal agencies in connection with lawful requests for information about you from your former employers, educational institutions, and financial or other organizations. The information gathered through the use of the number will be used only as necessary in personnel administration processes carried out in accordance with established regulations and published notices of systems of records. The SSN also will be used for the selection of persons to be included in statistical studies of personnel management matters. The use of the SSN is made necessary because of the large number of present and former Federal employees and applicants who have identical names and birth dates, and whose identities can only be distinguished by the SSN.

VA FORM

10-2850c

PAGE 4

NOV 2016 (R)
⇩ PDF Form

File Attributes

Fact Name Description
Form Purpose The VA 10-2850c form is used by individuals applying for positions in the health care professions within the Veterans Health Administration.
Form Users Applicants for positions such as nurses, physician assistants, and expanded-function dental auxiliaries.
Submission Requirement This form must be completed and submitted as part of the application process for health care positions within the VA system.
Key Sections Includes personal information, professional history, references, and licensure information.
Confidentiality Information provided on the form is handled in accordance with federal privacy laws and regulations to protect applicants' personal data.
Governing Law(s) Federal laws governing employment and privacy within the United States apply, as the VA is a federal agency. State-specific laws may not directly govern this form.

How to Fill Out VA 10-2850c

Filling out the VA 10-2850c form is a crucial step for healthcare professionals seeking positions at VA facilities. This form helps the Department of Veterans Affairs evaluate eligibility and qualifications for employment. By providing detailed information about your background, education, and professional experience, you're taking a key step towards potentially working with veterans. The process might seem daunting at first, but breaking it down into steps makes it more approachable. Below is a guide to help you complete the form accurately and thoroughly.

  1. Start by gathering all necessary documents and information, such as your resume, professional licenses, and education details. Having these on hand will make the process smoother.
  2. Enter your personal information, including your full name, Social Security Number, and contact details. Ensure that all information is current and correct.
  3. Fill out your professional experience section comprehensively. Include all relevant positions you’ve held, starting with your current or most recent job. For each position, provide the employer's name, your job title, dates of employment, and a brief description of your duties.
  4. Detail your professional licenses and certifications. Indicate the type of license, the issuing state or body, license number, and expiration date. If you have more than one license, include information for each.
  5. Education is next. List all educational institutions attended post-high school, including the name of the institution, degree obtained, and date of graduation. Highlight any honors or distinctions received.
  6. References play a critical role. Provide a minimum of three professional references who can attest to your qualifications and work ethic. Include their names, titles, relationship to you, and contact information.
  7. Respond to questions regarding your background and eligibility. Answer honestly about any history of licensure issues, felony convictions, or substance abuse. These questions must be answered accurately to avoid processing delays.
  8. Sign and date the form. Your signature certifies that all information provided is true and correct to the best of your knowledge. Verify that all sections are completed before signing.
  9. Last but not least, double-check the entire form for accuracy and completeness. Incorrect or missing information can lead to delays in the review process.
  10. Submit the form as directed by the job posting or by contacting the VA facility where you wish to apply. You may be asked to provide additional documents, so keep copies of your form and all relevant documents for your records.

After submitting the VA 10-2850c form, you might be waiting for a response regarding the next steps. These will typically involve further screening processes, interviews, and potentially job offerings. It’s important to respond promptly to any requests for additional information or documents. Remember, the effort you put into accurately completing this form is a step towards a rewarding career supporting our veterans.

Frequently Asked Questions

What is the VA 10-2850c form?

The VA 10-2850c form, officially known as the "Application for Associated Health Occupations," is a document used by the Department of Veterans Affairs (VA). This form is essential for individuals seeking to work in various healthcare positions within the VA system. It collects detailed information about the applicant's qualifications, educational background, employment history, and professional credentials necessary for the application process.

Who needs to fill out the VA 10-2850c form?

Not everyone applying for a job with the VA will need to fill out this form. It is specifically designed for candidates applying for associated health occupations, such as nurses, pharmacists, dentists, and other healthcare professionals. If you're applying for an administrative or support role, you will likely not need to complete this form.

How can I submit the VA 10-2850c form?

Submitting the VA 10-2850c form can be done through several methods, depending on the specific instructions provided by the VA job announcement you're responding to. Here are the common ways to submit your form:

  1. By Mail: Some positions may require you to print and mail the completed form to a specified address.
  2. Electronically: Many applications can be submitted online through the VA's job application portal.
  3. In Person: In some cases, you may be asked to bring your completed form to your interview or hand it directly to the Human Resources department at a VA facility.

Always check the job listing for specific submission instructions.

What happens after I submit my VA 10-2850c form?

After you submit the VA 10-2850c form, several steps will occur as part of the hiring process:

  • The VA will review your application and form to ensure you meet the basic qualifications for the position.
  • If your application is successful, you may be contacted for an interview or further assessment.
  • Your references and credentials will be verified, and a background check will be conducted.
  • Should you pass all these steps, the VA will extend a job offer, contingent upon satisfying any remaining conditions of employment.

Please note that the duration of this process can vary widely based on the role, the number of applicants, and other factors.

Common mistakes

Filling out the VA 10-2850c form, crucial for individuals seeking positions within the Veterans Health Administration, often comes with a few common pitfalls. These mistakes can delay the hiring process, affecting an applicant's chances of securing a timely position. Being aware of these errors is the first step towards submitting an impeccable application.

One common mistake is not checking the form for completeness. Many applicants leave sections blank, assuming they are not applicable. However, every section needs to be reviewed and filled out correctly. If a particular area does not apply, indicating this with an "N/A" or "Not Applicable" ensures the form is thoroughly completed. Overlooking this can send a signal of inattention to detail.

Another frequent oversight is not providing detailed employment history. The VA 10-2850c form requires a comprehensive work history, yet often individuals provide minimal information. This history helps the Veterans Health Administration understand an applicant's background, qualifications, and suitability for the role. Insufficient details may lead to unnecessary back-and-forth, delaying the process.

Incorrect or outdated personal information is a further error that applicants make. Whether it's a change in address, email, phone number, or name change, having outdated information can significantly hinder communication. It's imperative that all personal information is current and accurate, ensuring a smooth communication flow.

A notable mistake is neglecting to sign and date the form. This oversight may seem minor, but an unsigned or undated form is considered incomplete and will not be processed until corrected. Ensuring the document is fully signed validates that the information provided is true and allows for its evaluation.

Applicants often miss attaching necessary documentation. The VA 10-2850c form requires accompanying documents such as proof of certification, licenses, and educational background. Failing to attach these documents can delay the review process, as the application package is deemed incomplete.

Not following specific instructions for the form's submission can also be problematic. Whether it requires mailing, faxing, or electronic submission, each method has its protocols. Ignoring these specified instructions can result in the application not reaching the intended department or getting lost in transit.

Another common mistake is using an earlier version of the form. The Veterans Health Administration periodically updates the VA 10-2850c form. Using an outdated version might mean missing new requirements or providing information that’s no longer needed. Always double-check that the most recent form is being used.

Lastly, some applicants do not review their application for errors before submitting. A quick review can catch simple mistakes such as spelling errors, incorrect dates, or omitted information. Taking the time to proofread can make a significant difference in the application's processing time and accuracy.

Documents used along the form

When applying for healthcare positions within the Department of Veterans Affairs (VA), the VA Form 10-2850c is a crucial document. This form, specifically designed for advanced practice nurses, physician assistants, and several other medical professionals, serves as an application for employment. However, to complement this application and provide a comprehensive profile of the applicant's qualifications, other forms and documents are often required. The following is a list of six such documents that are frequently used alongside the VA 10-2850c form.

  • Resume or Curriculum Vitae (CV) - This document provides a detailed overview of the applicant's education, work history, certifications, and other relevant experiences. It is essential for giving the employer a comprehensive view of the candidate’s qualifications.
  • Transcripts - Official transcripts from colleges or universities attended are required to verify educational qualifications claimed by the applicant. These are particularly important for positions that have specific educational requirements.
  • Professional Licenses - Copies of active, current licenses are necessary to demonstrate that the applicant is legally permitted to practice in their respective healthcare field.
  • Board Certifications - For certain positions, especially those involving specialized medical care, documentation of board certifications can bolster an application by showing recognized competence in specific areas.
  • Letters of Recommendation - These letters from colleagues, supervisors, or educators can provide insight into the applicant's capabilities, work ethic, and interpersonal skills. They often give a more personal touch to the application.
  • Proof of Citizenship - Since the VA is a federal agency, it requires proof of U.S. citizenship for employment. This can be provided through a passport, birth certificate, or other government-issued documents indicating citizenship status.

Together with the VA Form 10-2850c, these documents create a comprehensive package that allows VA hiring managers to thoroughly assess the qualifications and suitability of candidates for healthcare positions. It is advisable for applicants to ensure they have these documents prepared and updated to facilitate a smooth and efficient application process.

Similar forms

The VA 10-2850c form is akin to the OPM SF-86, a Questionnaire for National Security Positions. Both forms are extensive and thorough, designed to collect detailed personal information for background checks. While the VA 10-2850c is specific to healthcare professionals seeking employment with the Veterans Affairs, the SF-86 is broader, used by individuals applying for federal positions that require security clearance. The similarity lies in their purpose to evaluate the suitability of candidates for sensitive roles.

Similarly, the form shares characteristics with the DEA Form 224, Registration for Dispensing Controlled Substances. Both are federal forms but serve different regulatory aspects of healthcare professions. The VA 10-2850c assesses qualifications and backgrounds of healthcare providers, while the DEA Form 224 is specific to professionals prescribing controlled substances, ensuring they meet legal and professional standards to handle these medications.

The I-9 Employment Eligibility Verification form also shares a connection with the VA 10-2850c. Both documents are integral to the onboarding process of new hires, confirming eligibility for employment. The VA form focuses on the professional and background qualifications specific to healthcare roles within the Veteran Affairs, whereas the I-9 is a universal form, used by all U.S. employers to verify the identity and employment authorization of their employees.

The HCFA-1500 (Health Care Financing Administration) form, now known as the CMS-1500, has similarities to the VA 10-2850c in the realm of healthcare. Though the CMS-1500 is primarily used for billing medical claims to Medicare and other health insurance companies, both forms are indispensable to the healthcare process. The VA form qualifies the professionals, and the CMS-1500 facilitates the billing for services provided by such professionals.

The Common Application for college is conceptually akin to the VA 10-2850c, with both forms serving as gateways to new opportunities within their respective fields. The VA form is used by professionals seeking healthcare positions within the Veterans Affairs system, whereas the Common Application is used by students applying to multiple colleges and universities. Each collects detailed personal information, educational backgrounds, and qualifications to assess suitability and eligibility.

Form FDA 1572, Statement of Investigator, is another document that shares a similar purpose with the VA 10-2850c. Both are used in highly regulated sectors—healthcare for the VA form and clinical trials for the FDA form. While the VA 10-2850c is for employment, the FDA 1572 ensures that investigators conducting clinical trials are qualified to uphold the safety and integrity of the research, aligning with the goal of ensuring professionals are fit for their roles.

Another similar document is the NRMP (National Resident Matching Program) application used by medical graduates seeking residency placements. Like the VA 10-2850c, it’s a critical step in the career path of healthcare professionals. Both require detailed personal and professional information to match candidates with suitable positions—residencies for NRMP applicants and VA healthcare roles for the VA form users.

The FCC Form 605, Quick-Form Application for Authorization in the Ship, Aircraft, Amateur, Restricted and Commercial Operator, and General Mobile Radio Services, mirrors the VA 10-2850c in its role of vetting professionals in a specialized field. Though one is for healthcare professionals and the other for communications operators, both ensure applicants meet specific criteria necessary to perform their duties effectively and safely.

The TSA PreCheck Application form also shares similarities with the VA 10-2850c. Both streamline the process for individuals to be pre-verified for their respective roles—healthcare employment in the VA and expedited screening for frequent travelers. While serving vastly different purposes, they both simplify subsequent procedures for the applicant, ensuring a smoother and more efficient verification process.

Last but not least, the ACGME Application for Residency and Fellowship Programs aligns closely with the VA 10-2850c. Both are key to career progression within the healthcare field—VA form for potential employment in Veterans Affairs healthcare settings and ACGME form for medical residents and fellows seeking program accreditation. They gather comprehensive information to ensure candidates meet the qualifications for their intended paths.

Dos and Don'ts

The VA 10-2850c form is an important document for anyone applying for certain positions within the Department of Veterans Affairs. Completing this form accurately and completely is crucial to ensuring a smooth application process. Here are some do’s and don’ts to guide you through the process:

Do:
  • Read the instructions carefully before you start filling out the form. This can save you time and prevent mistakes.
  • Use black ink or type your answers if the form is submitted on paper. This ensures legibility for all reviewers.
  • Provide accurate information about your professional qualifications, including licenses, education, and employment history. Honesty is key in all your answers.
  • Double-check your answers for any potential errors or omissions. Ensuring the accuracy of your information can help prevent delays in your application.
  • Sign and date the form if required. An unsigned or undated form may not be processed.
  • Follow the submission guidelines as provided. Whether you are submitting online or via mail, knowing where and how to send your completed form is crucial.
Don’t:
  • Rush through the form without paying attention to detail. Mistakes can cause unnecessary delays.
  • Leave sections blank unless instructed. If a question does not apply to you, it’s often better to write “N/A” than to leave the space empty.
  • Use corrections fluid or tape on the form if you make a mistake. Instead, if possible, start a new form, or clearly cross out errors and write the correction nearby.
  • Forget to list any relevant professional references or contacts who can verify your qualifications and experience. These references are important for the verification process.
  • Ignore the form’s specific requirements regarding documentation of your credentials. If you need to attach additional documents, make sure they meet the requested standards and formats.
  • Submit the form without reviewing the entire document. A final check to ensure that all information is correct and complete can save a lot of trouble down the line.

Misconceptions

The VA 10-2850c form, often required for healthcare professionals seeking employment with the Veterans Affairs (VA), comes with its share of myths and misunderstandings. Here are five common misconceptions about this particular form:

  • All healthcare professionals must complete this form. In reality, the VA 10-2850c form is specifically designed for certain positions within the VA healthcare system, including advanced practice nurses, physician assistants, and several others. Not every healthcare worker applying to the VA needs to fill out this version of the form.
  • Once submitted, the information on the form cannot be changed. It's understandable to worry about making a mistake on an important document. However, if there is a need to correct or update information after the form has been submitted, it is possible to do so. Contacting the VA directly is the best course of action for addressing any inaccuracies or updates.
  • The form can only be submitted online. While the digital submission of forms is increasingly common, the VA accepts the 10-2850c form through multiple channels. These include mailing a printed copy or even hand-delivering it to the appropriate VA facility, in addition to the option of submitting it electronically.
  • Completing the form is a quick process. Given the comprehensive nature of the form, filling it out can be quite time-consuming. It requires detailed information about one's professional history, licensure, and other qualifications. Applicants should set aside ample time to ensure the form is completed accurately and thoroughly.
  • There's no need to provide supporting documents. This is a common misconception. In fact, submitting the VA 10-2850c form is often just one step in the application process. Applicants may also need to provide additional documents, such as copies of professional licenses, certifications, or proof of previous employment. Carefully review the requirements related to the VA 10-2850c form to ensure all necessary documentation is submitted.

Understanding these misconceptions can streamline the process of applying for a position with the VA, ensuring that all necessary steps are taken care of correctly and efficiently.

Key takeaways

The VA 10-2850c form is a crucial document for individuals pursuing employment in the healthcare sector within the Department of Veterans Affairs (VA). Understanding the appropriate way to fill out and use this form is essential for a smooth application process. Here are six key takeaways to consider:

  • The VA 10-2850c form is specifically designed for healthcare professionals applying for positions at VA facilities. This includes roles such as nurses, physicians, and other allied health positions.
  • Accuracy and completeness are paramount when filling out the form. Applicants should ensure all sections are completed truthfully to the best of their knowledge. Missing or incorrect information can delay the application process or affect eligibility for employment.
  • The form requires detailed information regarding an applicant's professional history, licensure, and education. It's advisable to have all relevant documents at hand before beginning the application to make the process as smooth as possible.
  • Sections of the form that do not apply to the applicant should be marked with "N/A" for "Not Applicable." This indicates to reviewers that the question was read, but does not pertain to the applicant's situation.
  • Before submitting, applicants should review the form for any possible errors or omissions. It's beneficial to have a peer or mentor review the form as well, as they may catch mistakes the applicant has overlooked.
  • Finally, the submitted form is a part of the official application for employment with the VA. It's important to retain a copy for personal records, as it may be necessary for future reference or to provide supplemental information if requested by the VA.

Filling out the VA 10-2850c form thoughtfully and accurately is a critical step for healthcare professionals seeking employment with the VA. Following these key points can help ensure that the application process proceeds as smoothly as possible.

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