Get Va 10-2850 2016-2026

Filling out the VA 10-2850 form is an essential step for those seeking appointment within the Veterans Health Administration as a physician, dentist, podiatrist, optometrist, or chiropractor. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to fill out the VA 10-2850 successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name in the first mandatory field. This should include your last name, first name, and middle initial.
3. In the next section, check the box that corresponds to your application for specialty or general practice. If applying for a specialty, identify it in the space provided.
4. Enter your present address, ensuring you provide complete information, including street address, city, state, and zip code. Include any apartment number if applicable.
5. Input your contact telephone number with the appropriate area code. You can provide both residence and business numbers if available.
6. Fill in your date of birth in the specified format, followed by the place of your birth which includes the city, state, and country.
7. Enter your social security number, which is mandatory, followed by your citizenship status. Indicate whether you are a U.S. citizen by birth, a naturalized citizen, or not a U.S. citizen, providing additional information if necessary.
8. If you have previously applied for an appointment in the VA, answer accordingly and provide the name of the office and date filed.
9. Indicate when inquiries may be made of your present employer, followed by your availability for employment.
10. Complete the military service section if applicable, providing dates of active service, serial or service numbers, branch of service, and type of discharge.
11. Provide details about your licensure, DEA/state certification, and specialty boards. List all states or territories where you have been licensed and confirm your current registration status.
12. Continue through the form, detailing your professional liability insurance, professional education, residency training, and employment history as outlined in the respective sections.
13. Conclude by signing and dating the certification section at the end of the form to confirm that all provided information is true and accurate.
14. After completing the form, you may save changes, download the completed form, or print it for your records before submitting.

Start filling out your VA 10-2850 form online today for a smooth application process.