TITLE EXISTING STOCK OF VA FORM 10-2850c JUN 2006 WILL BE USED. 19C. DATE MONTH DAY YEAR PAGE 1 20A. SIGNATURE OF AUTHORIZED OFFICIAL VA FORM NOV 2016 R 10-2850c NO CURRENT OR PREVIOUS CLINICAL PRIVILEGES 19B. Approved Exception To SF 171 OMB No* 2900-0205 Estimated burden 30 minutes Use TAB key or Mouse to move between data fields APPLICATION FOR ASSOCIATED HEALTH OCCUPATIONS SEE LAST PAGE FOR PAPERWORK REDUCTION ACT PRIVACY ACT AND INFORMATION ABOUT DISCLOSURE OF YOUR SOCIAL SECURITY...
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What is the Application for Associated Health Occupations?

The Application for Associated Health Occupations (also known as VA 10-2850c) is a form for healthcare professionals to apply to work in the Department of Veteran Affairs. Because the Department of Veteran Affairs is a federal government agency, this is an application for a federal job.

In one sentence, what is the purpose of submitting this form?

The purpose of submitting form VA 10-2850c is to obtain federal employment as a healthcare professional with the Department of Veteran Affairs.

What information do you need in order to complete this form?

While the form itself is fairly straightforward, many pieces of information are needed. These pieces of information include…

The position for which you wish to be employed. This varies from Physical Therapist to Physician’s Assistant.

The full legal name of the applicant,

The full residential address of the applicant.

The applicant’s specialty field, or if not applicable, general practice.

The residential and business telephone numbers where the applicant can be reached.

The full date of birth for the applicant.

The City, State, and Country where the applicant was born.

The applicant’s social security number.

Citizenship details for the applicant.

Information on where the application was filled out and submitted.

Information on contacting previous employers.

Any information regarding active military duty.

All medical licensure information, including states you are licensed in, license numbers, current registration, and expiration dates.

Liability insurance information.

Health education qualifications.

Recent professional experience.

References, and their contact information.

Signatures authorizing release of information about you.

There are also many yes or no questions which will need to be answered on the third page of the application.

 

Who is the intended recipient of this form?

 

The recipient of this form is the relevant Department of Veteran Affairs to which you are applying. This is usually your local chapter.

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Instructions and Help about 10 2850c application for associated health occupations form

Laws dot-com legal forms guide ABA form 10-20 850 C is a United States Department of Veteran Affairs form used for the application for employment in the Associated health occupations the VA form 10-20 850 C is available on the Veterans Affairs documentation website or can be supplied through a local Veterans Affairs office the first box is used to identify the position for which you are applying select a position for which you are applying if the position is not one of the named options select other and write in the position in the box boxes 2 through 12 are used for your personal identification information fill in the appropriate boxes with your name address contact information date of birth social security number citizenship and past applications with the Veterans Affairs Department in section 1 box 13 identify whether you are currently or have ever been on active military duty if you have never been on active duty leave these boxes blank section two is to be used to identify all licenses or certifications that you hold in boxes 14 through 17 you must indicate all licenses that you currently hold or have held in the past do not leave out any certifications if you need additional space for your list attach them as an addendum at the end of the application do not fill in information in section 3 this is for use only by the reviewing agency if you have any current or previous professional liability insurance you must identify the carrier in section 4 and state whether your insurance has ever been cancelled if you have had professional liability insurance cancelled or denied you must write a brief explanation on a separate sheet and detention at the end of the VA form 10-20 850 C in sections 5 & 6 you must give a complete description of your education history and professional experience section 7 & 8 are to be used for additional information and professional references make sure to include all publications papers and honors as they will help your application through the evaluation process items 28 through 37 are general questions for employment with the federal government for which you must supply yes or no answers finally certified the VA form 10-20 850 see with your signature and submitted to the proper office for processing to watch more videos please make sure to visit laws dot-com