INSTRUCTIONS : APPLICATION FOR ASSOCIATED HEALTH OCCUPATIONS (VA Form 10-2850c)
A VA Form 10-2850c is a United States Department of Veteran Affairs form used for the application for employment in the associated health occupations.
The VA Form 10-2850c 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.
1. Select the 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.
2. 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 I, box 13, identify whether you are currently or have ever been on active military duty.
3. If you have never been on active duty, leave these boxes blank.
Section II is to be used to identify all licenses or certifications that you hold.
4. 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 III, 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 IV and state whether your insurance has ever been canceled.
5. If you have had professional liability insurance canceled or denied, you must write a brief explanation on a separate sheet and attach it at the end of the VA Form 10-1850c.
In Sections V and VI, you must give a complete description of your education history and professional experience.
Sections VII and VIII are to be used for additional information and professional references.
6. 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, certify the VA Form 10-2850c with your signature and submit it to the proper office for processing.
