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Directions for VA Form 10-2850C

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The U.S. Department of Veterans Affairs recruits for individuals to fill positions in sub-agencies, such as the central office, Veterans Health Administration (VHA), Veterans Benefits Administration (VBA) or the National Cemetery Administration (NCA). The hiring process includes a completed application and required forms related to the specific announcement number. Individuals interested in jobs in the associated health occupations must complete a VHA 10-2850C form as their application.

Download the VHA 10-2850C form (see Resources) and open the document in Adobe Acrobat Reader.

Select the occupation for which application is being made in box 1.

Enter biographical information in boxes 2 through 9B.

Enter information about application filing in boxes 10A through 12.

Enter information about active military duty service in section I. If a discharge other than honorable is received, draft an explanation of discharge on a separate sheet and attach the explanation to the form.

Enter information about licenses, DEA certification, registration and clinical privileges as applicable in boxes 14A through 17C in section II. Attach drafted explanations if any of the following situations are applicable:

  • A license is not held. - Current registration is not active. - A license is restricted, limited or probational. - Licenses have ever been revoked, suspended, denied, restricted, limited, issued/placed on probation status or voluntarily relinquished. - Registration is no longer held or current for a practice. - Action has been taken against certification or registration. - Staff appointments or clinical privileges have been denied, revoked, suspended, reduced, limited or voluntarily relinquished.

Request completion of section III from the facility director or designee.

Complete section IV "Liability Insurance (as applicable)." If insurance has ever been canceled, denied or renewal refused, you must draft an explanation on a separate sheet and attach the explanation to the form.

Complete sections V-VIII. Attach additional sheets as necessary.

Answer questions in boxes 28 through 37. Attach additional explanations as needed.

Sign and date the application in boxes 38A and 38B.

Complete the "Authorization for Release of Information," choosing applicable authorizations and releases. Sign and date the form.

Submit the application and all supporting documentation and explanations to the administration. Contacts and addresses for specific job openings are listed on the announcement. Include the job announcement number on your application.


Applicants should be thorough while completing the form and double-check the application packet to ensure that all supplemental information is attached as required.


Incomplete applications will not be considered for further review. If an application is not reviewed due to incomplete information, future applications may not be accepted.