VA Form 10-2850c Application for Associated Health Occupations

How to Fill Out VA Form 10-2850C?

No VA Form 10-2850C instructions are provided with the form. Detailed step-by-step filing instructions can be found below:

1. The first box of the form contains the occupations available for application. The applicant must select "Other" and identify the occupation if the desired position is not featured on the list.
2. Boxes 2 through 12 should contain the applicant's personal information. This includes their name, address, date, and place of birth, Social Security Number, and citizenship information. Box 3 is filled in if the candidate is applying for a certain specialty.
3. If the applicant had ever filed the application before, this should be specified in Boxes 10a through 10c.
4. Section I describes the applicant's military service. The individual must specify whether or not they have served on active military duty. If the answer is negative, the section should be left blank.
5. Box 13e requires the type of discharge. Any other-than-honorable discharge requires a further explanation on a separate sheet of paper that must be attached to the form.
6. Section II pertains to licensure: Drug Enforcement Administration (DEA) certification, registration, and clinical privileges (if applicable). The applicant has to provide full information on their licenses: where and when the license was obtained, the number of licenses, the current registration, and the expiration date.
7. Boxes 15a through 15c require information regarding any problems with the license: whether it was restricted, suspended or denied in any state. Boxes 16a through 16d require the certifying body for the current occupation, the most recent certification date, and its number, the specification, and whether or not any action was taken against certification or registration. Additional sheets may be used to include all the certifications or to explain the information given.
8. Section III is to be completed by the reviewing agency.
9. Section IV provides information about liability insurance. It is filled as stated only if applicable.
10. An applicant's qualifications must be described in Section V. Boxes 22a through 22e specify the name of schools, their address (including ZIP code), the program length, the date of completing the program, and the documents that verify attendance (a diploma or the awarded degree).
11. Section VI describes the previous professional experience. Column 24a is for listing the names of previous employers. Column 24b is for providing their addresses. Column Box 24c is for specifying the occupation in every case.
12. The form of contract (either full or part-time) is identified in Column 26d. If the applicant was a part-time employee, the average number of hours per week is given in Column 26e. Column 26f indicates the period of employment for each place of occupation.
13. Section VII provides space for any additional information. Box 25 is filed by applicants employed under any names other than the one specified in Box 2. Any publications, awards, grants, or fellowships should be listed in Box 26.
14. The qualifications for every candidate must be provided by qualified professionals not related to the applicant by blood or marriage. These people should be listed as references in Section VIII, Boxes 27a through 17d.
15. Boxes 28 through 37 contain yes-or-no questions that need to be answered by the applicant. These include questions about any previous convictions or imprisonment, being discharged from a position, and having Federal debts.
16. The applicant must certify the provided information by signing the form in Box 38 and once again in the space provided on the fourth page of the form.

Not what you were looking for? Check out these related forms:

• VA Form 10-2850, Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors;
• VA Form 10-2850A, Application for Nurses and Nurse Anesthetists;
• VA Form 10-2850D, Application for Health Professions Trainee;
• VA Form 10-2850B, Application for Residents (obsolete).