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  • Lebanon Medical Attachment Form

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ATTACHMENT TO SF-85 The attached affidavit must be completed before we can appoint you. This form along with a copy of your fingerprints which will be made at the VA Medical Center by the Police Service are necessary for your security investigation. If this form is not completely filled out it WILL be returned until ALL questions are answered. Complete as much as possible prior to your appointment date. If you have any questions contact HUMAN RESOURCES 121 VA MEDICAL CENTER 1700 S. LINCOLN AVENUE LEBANON PA 17042 717 272-6621 extension 4053 or 4054 If you intend to drive your own vehicle to work you must also bring your driver s license vehicle registration for each vehicle you may drive to work and insurance verification. FULL NAME - NO INITIALS LAST NAME FIRST NAME MIDDLE NAME RESIDENCE OF PERSON FINGERPRINTED COMPLETE ADDRESS DATE OF BIRTH MONTH/DAY/YEAR SEX RACE HEIGHT PLACE OF BIRTH CITY STATE EYE COLOR HAIR COLOR SCARS MARKS AND TATTOOS POSITION TO WHICH APPOINTED SOCIAL SECURITY....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232