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The DCA 25A 1 form is a critical document for individuals seeking licensure as veterinarians in California. This form serves as an application for the Veterinary Medical Board, collecting essential information from applicants. It covers a variety of important aspects, starting with application type and fees, guiding candidates on the costs involved in the licensure process, which can amount to several hundred dollars depending on the examinations required. Personal information is a significant part of the document, including the applicant's name, social security number, contact details, and physical description. The form also inquires about the applicant's educational background, specifically the colleges attended, degrees earned, and the experience they possess in different jurisdictions where they may already be licensed. Additionally, applicants must disclose any prior disciplinary actions or criminal convictions, ensuring transparency and compliance with state regulations. For military spouses or partners, there is a provision for expedited processing, reflecting sensitivity to the unique circumstances of those serving in the armed forces. Lastly, the DCA 25A 1 form highlights the applicant's responsibility to report any criminal charges or disciplinary actions that arise after submission, underscoring the importance of integrity throughout the professional licensing process. Completing this application correctly and thoroughly is vital for those aspiring to practice veterinary medicine in California.

Dca 25A 1 Example

BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY • GOVERNOR EDMUND G. BROWN JR.

Veterinary Medical Board

1747 N. Market Boulevard, Suite 230, Sacramento, CA 95834 Telephone: 916-515-5220 Fax: 916-928-6849 | www.vmb.ca.gov

VETERINARY APPLICATION

1.APPLICATION TYPE/FEES - check fees you are paying

 

$125.00 - Application Evaluation Fee

 

 

 

 

 

 

 

 

 

Office Use Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application Fee is Required for all Applications

 

 

 

 

 

Receipt

 

 

_______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$200.00 - State Board Examination Fee

 

 

 

 

Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

_______________________________

 

 

$100.00 - California Veterinary Law Examination Fee, if

 

 

Cashiered:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

applicable

 

 

 

 

 

 

 

 

 

 

ATS ID:

 

 

_______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please make check or money order payable to the “VMB”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount

 

 

_______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mail application, supporting documents, and fee to:

 

 

 

 

 

 

 

 

 

Paid:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Veterinary Medical Board

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________

 

 

1747 N. Market Blvd., Suite 230

 

 

 

 

 

Refund:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sacramento, CA 95834

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. APPLICANT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST

FIRST

 

 

 

 

MIDDLE

 

 

 

 

BIRTHDATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT MAILING ADDRESS

 

 

 

CITY

 

 

STATE

 

 

ZIP

 

 

 

 

COUNTRY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERMANENT MAILING ADDRESS

 

 

 

CITY

 

 

STATE

 

 

ZIP

 

 

 

 

COUNTRY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U.S. SOCIAL SECURITY NUMBER*:

 

 

 

 

 

 

 

TELEPHONE NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMAIL ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Disclosure of a social security number is mandatory and must be provided prior to licensure This number must be a United States social security number. Social security

 

numbers from other countries will not be accepted. Section 30 of the Business and Profession Code and Public Law 94-455 [42 USC 405(c)(2)(C)] authorize collection of the

 

Social Security number. Your Social Security number will be used exclusively for tax enforcement purposes and for purposes of compliance with any judgment or support order

 

in accordance with Section 17520 of the Family Code.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. PHYSICAL DESCRIPTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HAIR COLOR

 

HEIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EYE COLOR

 

WEIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTACH PASSPORT

I HEREBY DECLARE THAT THE ATTACHED PHOTO

 

 

 

 

 

 

 

 

 

 

 

SIZE PHOTO HERE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WAS TAKEN ON OR ABOUT (MONTH/DAY/YEAR):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CANDIDATE SIGNATURE ___________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. EDUCATION INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLLEGE OR UNIVERSITY

 

 

 

FROM

 

TO

 

 

COURSE

 

 

GRADUATION DATE

DEGREE RECEIVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. STATES/PROVINCES IN WHICH YOU ARE LICENSED AS A VETERINARIAN

STATE/PROVINCE

REGISTRATION #

 

 

DATE ISSUED

ISSUED BY EXAM OR CREDENTIALS

PERIOD OF PRACTICE

6. PREVIOUS APPLICATION(S) FOR CALIFORNIA

HAVE YOU EVER APPLIED TO TAKE THE VETERINARY EXAMINATION IN CALIFORNIA?

YES

NO

7. DISCLOSURE OF DISCIPLINARY ACTION

HAVE YOU EVER HAD DISCIPLINARY PROCEEDINGS AGAINST ANY LICENSE TO PRACTICE VETERINARY MEDICINE INCLUDING REVOCATION, SUSPENSION, PROBATION, VOLUNTARY SURRENDER, OR ANY OTHER PROCEEDING?

If Yes, please provide detailed written explanation, include the date and state where the discipline occurred.

YES

NO

8. CONVICTION OF MISDEMEANOR OR FELONY

HAVE YOU EVER BEEN CONVICTED OF ANY OFFENSE OTHER THAN MINOR TRAFFIC VIOLATIONS OR PLED NO CONTEST TO A VIOLATION OF ANY LAW OF ANY STATE, THE UNITED STATES, OR A FOREIGN COUNTRY?

If Yes, please provide detailed written explanation.*

YES

NO

*You must include all misdemeanor and felony convictions, regardless of the age of the conviction, including those which have been set aside and/or dismissed under Penal Code Section 1000, 1203.4 or 1210.1. Traffic violations involving driving under the influence, injury to persons or providing false information must be reported. The definition of conviction includes convictions following a plea of nolo contendere (no contest) as well as pleas or verdicts of guilty.

9. EXPEDITED APPLICATION FOR SPOUSES OR DOMESTIC PARTNERS OR ACTIVE DUTY MILITARY PERSONNEL

ARE YOU A SPOUSE OR DOMESTIC PARTNER OF ACTIVE DUTY MILITARY PERSONNEL?

If Yes, you may qualify for expedited application processing.*

YES

NO

*An applicant for expedited application processing must meet the following requirements: 1) provide evidence that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in California under official active duty orders and, 2) hold a current license in another state, district, or territory of the United States in veterinary medicine.

10. CERTIFICATION SIGNATURE AND DATE

I understand that I am required to report immediately to the California Veterinary Medical Board if I am convicted of any offense that occurs between the date of this application and the date that a California veterinary license is issued. I am also required to report to the California Veterinary Medical Board any disciplinary action and/or voluntary surrender against any license as a veterinarian or any veterinary related license that occurs between the date of this application and the date that a California veterinary license is issued. I understand that failure to do so may result in denial of this application or subsequent disciplinary action against my license.

I certify, under penalty of perjury under the laws of the State of California, that all information provided in connection with this application for licensure examination is true, correct, and complete. Providing false information or omitting required information is grounds for denial of licensure or revocation of licensure in California.

Signature of applicant_____________________________________________________________ Date__________________________

NOTE: All items in this application are mandatory; none are voluntary, unless indicated. Failure to provide any of the requested information will result in the application being deemed incomplete. The information provided will be used to determine qualification for examination and licensure, per Section 4841-4842 of the Business and Professions Code which authorizes the collection of this information. Information regarding the issuance or denial of a license by the Board may be transmitted to any other veterinary medical licensing authority. Candidates have the right to review their application subject to the provisions of the Information Practice Act. The Executive Officer is custodian of records.

INFORMATION COLLECTION, ACCESS, & DISCLOSURE: Information you provide on this application is maintained by the Executive Officer of the Veterinary Medical Board, 1747 N. Market Blvd., Suite 230, Sacramento, CA 95834. The information is requested pursuant to Business and Professions Code sections 4832-4844 and/or Title 16, California Code of Regulations, Division 20, Article 6.

FORM 25A-1 (Rev. 09/2010)

Form Characteristics

Fact Name Description
Application Purpose The DCA 25A 1 form is used to apply for licensure as a veterinarian in California.
Fees There are three required fees: $125 for application evaluation, $200 for the state board examination, and $100 for the California Veterinary Law Examination.
Mandatory Disclosure Disclosure of a U.S. social security number is mandatory before licensure, as specified by California law.
Disciplinary History Applicants must disclose any past disciplinary actions against their veterinary licenses, including revocation or suspension.
Expedited Processing Spouses or domestic partners of active duty military personnel may qualify for expedited application processing.
Governing Laws The form operates under the California Business and Professions Code, specifically Sections 4841-4842.

Guidelines on Utilizing Dca 25A 1

Completing the DCA 25A 1 form is crucial for those seeking to become licensed veterinarians in California. Following the steps carefully will ensure that your application is processed without unnecessary delays. Gather all necessary information before starting to fill out the form.

  1. Review the application type and fees: Check the fees that apply to your application. You need to select the appropriate option(s) for the application evaluation and examination fees.
  2. Applicant information: Fill in your last name, first name, and middle name. Then, provide your birthdate, current and permanent mailing addresses, U.S. social security number, telephone number, and email address.
  3. Physical description: Provide details regarding your hair color, height, eye color, and weight. Attach a recent passport-sized photo to the designated space on the form.
  4. Education information: List the college or university you attended, the dates of attendance, the course of study, graduation date, and the degree received.
  5. Licensed status: Indicate the states or provinces where you hold a veterinary license. For each one, provide the registration number, date issued, issuing authority, method of examination or credentials, and the period of practice.
  6. Previous applications: State whether you have applied to take the veterinary examination in California before. Be honest in your response.
  7. Disciplinary history: Disclose any prior disciplinary actions taken against your veterinary license. If applicable, provide a detailed explanation, including the date and state involved.
  8. Criminal history: Answer whether you have ever been convicted of any offenses other than minor traffic violations. Include explanations for any affirmative answers.
  9. Expedited application eligibility: If applicable, answer whether you are the spouse or domestic partner of active duty military personnel. Include evidence if applicable.
  10. Certification: Sign and date the application to certify that all information is accurate. Understand the obligations to report any changes between application and licensure date.

What You Should Know About This Form

What is the DCA 25A 1 form and who needs it?

The DCA 25A 1 form is an application form required for individuals seeking to obtain a veterinary license in California. Whether you are a recent graduate or a licensed veterinarian from another state looking to practice in California, this form is essential for submitting your application for examination and eventual licensure.

What fees are associated with the DCA 25A 1 form?

There are several fees linked to the application process. A basic Application Evaluation Fee of $125 is required for all applications. If you need to take the State Board Examination, an additional fee of $200 applies. For those also taking the California Veterinary Law Examination, a fee of $100 is needed. Remember to make your payment via check or money order addressed to the “VMB.”

Is providing a Social Security number mandatory on this form?

Yes, providing a Social Security number is mandatory for all applicants. This requirement ensures compliance with tax enforcement and support orders as per relevant laws. Only U.S. Social Security numbers are accepted, so make sure you have yours ready for submission.

What kinds of previous actions must be disclosed on this form?

If you have ever faced disciplinary proceedings against any veterinary license, it's vital to disclose this information. This includes any revocations, suspensions, or probations. Additionally, any misdemeanor or felony convictions, excluding minor traffic violations, also need to be reported. Transparency in these areas is crucial for your application process.

How can I qualify for expedited application processing?

Expedited processing may be available if you are a spouse or domestic partner of active-duty military personnel. To qualify, you must provide evidence of your connection to the military member and hold a valid veterinary license from another U.S. jurisdiction. This can significantly speed up your application process.

What happens if I provide false information on the application?

It's imperative to provide accurate and complete information on your application. If you submit false information or fail to disclose necessary details, you risk having your application denied. In some cases, this could even result in the revocation of licensure if it is later discovered.

Do I need to submit a photo with my application?

Yes, a recent passport-size photo is a requirement for the DCA 25A 1 form. Be sure that your photo meets the size requirements and is attached as instructed. The quality of this photo is important, as it helps in the identification process once your application is reviewed.

Where should I send my completed application?

Once you have completed the DCA 25A 1 form, along with any supporting documents and payment, you should mail it to the Veterinary Medical Board at their Sacramento address: 1747 N. Market Blvd., Suite 230, Sacramento, CA 95834. Ensuring that all forms are sent correctly can help expedite the review process.

Common mistakes

Completing the DCA 25A 1 form is crucial for obtaining your veterinary license. However, many applicants make common mistakes that can delay the process. Awareness of these mistakes can help facilitate a smoother application experience.

One frequent issue is neglecting to include the correct fee. Applicants often overlook the requirement to check the appropriate boxes for the application type and corresponding fees. Double-check the calculated amount to ensure that no discrepancies exist. An incorrect payment can lead to immediate rejection of the application.

Another mistake involves providing incomplete information. All requested fields must be filled out, including personal details such as birthdate, social security number, and contact information. Missing information can cause your application to be deemed incomplete, leading to unnecessary delays.

Applicants sometimes misinterpret the disciplinary disclosure section. It’s crucial to answer truthfully regarding any past disciplinary actions. Omitting relevant details or providing vague explanations can jeopardize your application. Providing a clear and comprehensive account is essential for transparency.

A common slip is in the signature section. Ensure that you sign and date the application in the correct places. Failure to do so may result in the application being rejected. It’s a simple step that carries significant importance.

Moreover, many forget to attach the required photo with the application. Failure to include an appropriate-sized photo, as specified in the guidelines, may result in delays. Always verify that your photo meets the necessary requirements before submission.

Finally, applicants may skip reviewing their entire application before submission. Taking a few moments to carefully read through the form can reveal other mistakes or areas needing clarification. A thorough review helps ensure that everything is in order, allowing for a more efficient process towards obtaining your veterinary license.

Documents used along the form

The DCA 25A 1 form is an important application for individuals seeking licensure in veterinary medicine in California. Along with this form, several other documents are generally required to support the application process. Below is a list of commonly utilized forms and documents that often accompany the DCA 25A 1.

  • Official Transcripts: These documents provide evidence of an applicant’s educational background and degree completion from accredited veterinary institutions. Transcripts must be sent directly from the educational institution to verify the educational qualifications necessary for licensure.
  • Proof of Licensure from Other States: If an applicant is currently licensed in a different state, they must provide documentation that includes details about their licensure status. This can include verification letters or copies of licenses.
  • Criminal Background Check Form: To comply with state regulations, applicants are typically required to submit a form permitting a background check. This ensures that all candidates meet the ethical standards set for the profession.
  • Verification of Work Experience: Some applications may require a detailed account of professional experience in veterinary practice. Applicants may need to provide forms that confirm internships, residencies, or other relevant experiences under licensed veterinarians.

Collecting and submitting these documents alongside the DCA 25A 1 form is essential for a smooth application process. Ensuring completeness and accuracy can significantly affect the outcome of the application for veterinary licensure.

Similar forms

The DCA 25A 1 form serves an important purpose in the licensing process for veterinarians in California. Several other documents are similarly structured and used to collect essential information for professional licensure or application processes. Here’s a look at five such documents:

  • Veterinary Exam Application: This form is also used by applicants seeking to take the state veterinary examination. Similar to the DCA 25A 1 form, it gathers personal details, educational background, and any prior application history, enabling the state to verify qualifications.
  • Medical Board Application: Those applying for a license to practice medicine fill out this form. Just like the DCA 25A 1, it requires a comprehensive disclosure of education, professional history, and any disciplinary actions. This ensures that only qualified candidates receive a medical license.
  • Pharmacy Technician Application: This document is utilized for pharmacy technician licensure. Like the DCA 25A 1 form, it collects information about training, background checks, and personal identification, ensuring applicant eligibility in the pharmacy field.
  • Real Estate License Application: Similar in nature, this form is used for aspiring real estate agents. It also gathers personal information, educational history, and backgrounds related to any disciplinary issues, aligning with the common goal of determining a candidate’s suitability for licensure.
  • Cosmetology License Application: Individuals looking to obtain a cosmetology license must complete this form. Comparable to the DCA 25A 1, it requires details about training, prior practice, and any legal matters, contributing to a thorough assessment of applicants in the beauty industry.

In summary, these forms are vital tools in ensuring only qualified individuals are permitted to practice in their respective fields. They share a common format that mandates transparency and thoroughness in the application process.

Dos and Don'ts

Completing the DCA 25A 1 form accurately is crucial for a successful application process. Here are seven important do’s and don’ts to keep in mind:

  • Do double-check all personal information, including your name, address, and Social Security number, to ensure accuracy.
  • Do include all necessary fees, making sure to write your check or money order payable to “VMB.”
  • Do attach a recent passport-sized photograph, as this is a required part of the application.
  • Do answer all questions honestly, especially those regarding disciplinary actions or criminal convictions.
  • Don't omit any information, as failing to provide required data can result in your application being deemed incomplete.
  • Don't use a Social Security number from outside the United States; only a U.S. Social Security number is accepted.
  • Don't forget to sign and date your application; an unsigned application may cause delays.

Misconceptions

Misconception 1: The DCA 25A 1 form is only for new applicants.

This form is not exclusively for new applicants. It is also applicable for those who have previously applied for the veterinary examination in California. Past applicants must disclose their previous applications as part of their current submission.

Misconception 2: Social Security numbers can be submitted from any country.

This is incorrect. Only U.S. Social Security numbers are accepted. The form explicitly states that Social Security numbers from other countries will not be processed, aligning with state and federal regulations.

Misconception 3: Applicants do not need to report misdemeanors or felonies that are old or dismissed.

This is a common misunderstanding. All convictions—including those set aside or dismissed—must be reported. This requirement helps maintain transparency in the application process.

Misconception 4: Completing the DCA 25A 1 form guarantees licensure.

Filling out the form accurately does not guarantee a veterinary license. Licensure depends on a range of factors, including examination results and background checks. The form itself is just one part of a larger process.

Misconception 5: There are no consequences for providing false information.

This is misleading. The form explicitly states that providing false information or omitting necessary details is grounds for denial or revocation of licensure. It is imperative to be completely honest during this process.

Misconception 6: Expedited processing is available to everyone.

Expedited processing is limited. Only spouses or domestic partners of active-duty military personnel may qualify under specific conditions. These conditions require proof of marriage or partnership along with a current license from another state.

Key takeaways

Filling out the DCA 25A 1 form requires careful attention to detail. Ensuring that all information is accurate and complete is crucial, as any discrepancies can lead to application delays or denials. Double-checking for errors can save you time and frustration.

Timely submission of fees is essential. The application evaluation fee and other associated costs must be paid as specified. Late or incorrect payments can hinder your application process. Use a check or money order payable to "VMB" and keep a record of your payment.

Disclosure requirements are mandatory. You must provide your U.S. Social Security number as part of the application. This requirement is not just administrative; your number will be used for tax enforcement and compliance. Missing this information will result in an incomplete application.

Disciplinary history is taken seriously. If you have ever faced any disciplinary action or criminal convictions, be transparent in your disclosures. Failing to report such history can lead to serious consequences and impact your ability to secure licensure.