Fillable VA Form 10-2850C | Application for Associated Health Occupations

The VA 10-2850C form is provided by the Department of Veteran Affairs for the purpose of applying for employment in various and associated health occupations.

• Step 1 – Applying for Employment

The first box will be for selection of the position that you wish to apply for. Select the position you’re interested in. If the position is not listed choose the box marked “other” and fill in the position yourself. Boxes 2-12 will require your personal and contact information to include past applications with the Veteran’s Affairs Department. You must identify whether you have ever been on active duty, if not leave those sections blank.

• Step 2 – Licenses and/or Certifications

In boxes 14 -17 you must state all licenses and certifications that you currently hold or any license or certification that you have held in years past. Do not leave out any of this information even if past licenses are no longer in force. If you run out of space in this section you may add them as an addendum upon completion of your application. This is a necessary step for consideration. Leave section 3 blank.

• Step 3 – Professional Insurance Information

If you currently hold any type of professional liability insurance policies, you must list the policies and carriers of the policies. If you’ve ever been denied any insurance or if you’ve had professional insurance that has been canceled, you must state these as well. If you’ve had denials or cancellations you must offer a brief explanation on a separate sheet of paper and attach it to the application. Don’t leave out any information.

• Step 4 – Education

Sections 5 and 6 are specific to education and experience. You must be as complete as possible with these descriptions.

• Step 5 – Professional References

Sections 7 and 8 are for providing professional references and any additional information. Include any honors, publications or any papers that may assist in the evaluation.

• Step 6 – Government Questions

Boxes 28-37-These are general yes or no questions that must be answered.

• Step 7 – Certification of Information Provided

You must sign and date the form and submit to the appropriate VA office to be properly evaluated and processed.