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The Virginia Job Application form is a standardized document used by individuals seeking employment within the Commonwealth of Virginia. This form ensures that every applicant provides essential information needed by employers to evaluate their qualifications fairly and efficiently. It promotes an equal opportunity workplace by collecting data without bias based on personal characteristics.

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When applying for a position within the Commonwealth of Virginia, prospective employees will encounter the Virginia Job Application Form, officially known as DHRM Form 10-012. This comprehensive document is designed to collect essential information about an applicant’s education, work experience, and other relevant qualifications. At the onset, candidates will specify the position they are applying for, along with the agency name. Vital personal details such as full legal name, contact information, and Social Security number must be provided. Education is a key focus, where applicants can indicate their highest completed grades, any degrees earned, and relevant institutions attended. The experience section allows candidates to chronicle their past employment, including duties performed, the names of employers, and the duration of each role. Additional sections address topics like references, work availability, and willingness to travel. Also included are certifications for eligibility regarding federal laws and regulations. The application concludes with an affirming statement requiring the candidate's signature, signifying the truthfulness of the provided information. Overall, this form not only serves as a gateway to employment within the state but also ensures regulatory compliance and promotes equal opportunity in hiring practices.


	DHRM Form 10-012 (Rev. 9/03)					Commonwealth of Virginia

	Please print in ink (preferably black) or use typewriter					An Equal Opportunity Employer
	Number of attachments
						Application for Employment
	Position number

Send this application directly to the agency announcing the vacancy.

Employees of the Commonwealth and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, national origin, disability, marital status, gender or age.

As a means of accommodation to persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained by calling the agency to which you are applying.

1.	Position applied for		2. Agency
		(one per application)	(Note: Completion of number three is optional. Failure to submit social
3.	Social Security No.
3.	Social Security No.		security number on this form will not prohibit employment consideration.
			Social security number may be required on other forms prior to employment.)

4.	Full legal name			6.		Home Phone	(	)
		Last	First	Middle
5.	Address			7.		Business Phone		( )
					8. E-mail Address
		City	State	Zip

9.EDUCATION

a.	Check highest grade completed	1	2 3	4 5	6	7	8 9	10		11	12
b.	If you did not complete high school, do you have a high school equivalency diploma?									Yes	No
c.	Check number of years of post high school education			1	2	3	4	5	6	7
Name and Location of Institution				Hrs		Degree			Major or Specialty			Minor	Dates Attended
						Received
1.
2.
3.

d. If you expect to complete an educational program in the near future, please indicate what type of degree or program and expected completion date:

10.EXPERIENCE — Use Supplementary Experience Form(s) for additional space. Starting with the most recent, describe ALL paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your qualifications for this position.

You may list significantly different jobs within the same organization as separate items. May we contact your present supervisor?

Yes

Job Title

Duties:

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Number and titles of employees you supervised

Salary (start)

(finish)

Equipment used

Dates (mo/yr)

to (mo/yr)

Reason for leaving

Full-time

Part-time

Hours/week

Your name if different from present

Job Title

Duties:

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

c. Job Title

Duties:

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Number and titles of employees you supervised

Salary (start)

(finish)

Equipment used

Dates (mo/yr)

to (mo/yr)

Reason for leaving

Full-time

Part-time

Hours/week

Your name if different from present

d.Use this space for any additional information you think would help us evaluate your application, including training, seminars, workshops, and special achievements or specialized skills:

e.Automated word processing (specify equipment)

	Typing speed	words per minute.		Shorthand speed	words per minute
f. License (to include driver’s), certificate or other authorization to practice a trade or profession.
	Type		License Number		Granted by (licensing board)

11.REFERENCES

List names, addresses and relationships of three persons not related to you who know your qualifications:

Name	Address	Phone	Relationship

12.MISCELLANEOUS

a.	Check which shift you will accept:		Day	Evening	Night	Rotating	Weekends		Specify shift hours
b.	Check which job status you will accept:		Full-time		Part-time (specify)
c.	Check which employment status you will accept:			Salaried (benefits)		Hourly (No benefits)			Part-time salaried (leave benefits only)
d.	Are you willing to accept employment which requires you to travel? No					Yes. If yes,		During the day only,
	Occasionally overnight,		Frequently overnight.
e.	List the geographic locations in which you are willing to work. If anywhere in Virginia, write “all”
f.	Are you willing to provide your own transportation if necessary for your employment?						Yes	No.
g.	For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States?
	Yes	No. Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you
	are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be
	employed.

h.Section 2.2-2804 of the Code of Virginia prohibits any board, commission, department, agency, institution or instrumentality of the Commonwealth from employing a person who is required to present himself and submit to the federal Selective Service registration

requirement and failed to do so. If you are/were required to register for the Selective Service, have you done so? Yes No. If no, state reason:

i.For purposes of compliance with Section 2.2-2903 of the Code of Virginia, are you a veteran who received an honorable discharge and has (i) provided more than 180 consecutive days of full-time active- duty in the armed forces of the United States or reserve components thereof, including the National the National Guard, or (ii) has a service-connected disability rating fixed by the United States Veterans Affairs?

Yes No. If yes, did you serve during the Vietnam Conflict (2/28/61-3/7/75)? Yes No

j.Have you ever been convicted* for any violation(s) of law, including moving traffic violations. Yes No If YES, please provide the following:

Description of offense:

Statute or ordinance (if known ): Date of Charge: ; Date of Conviction

County, City, State of Conviction:

(For additional convictions use plain paper. Include all information listed above.)

*Convictions include Virginia juvenile adjudications for Capital Murder, First and Second Degree Murder, Lynching, or Aggravated Malicious Wounding, if you were age fourteen (14) to eighteen (18) when charged.

13.When will you be available to start work? (No date is necessary if you are available as soon as you give two (2) weeks notice.)

Month Day Year

14.CERTIFICATION--Each Application Requires Current Date and Original Signature

I hereby certify that all entries on both sides and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment in the service of the Commonwealth of Virginia. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent that you may contact references, former employers and educational institutions listed regarding this application. I further authorize the Commonwealth to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the agency head or designee.

Date

Applicant Signature

Pursuant to federal regulations, we collect responses to the questions below for record keeping purposes. This information will NOT be kept with your application for employment. Federal law prohibits unlawful discrimination on the basis of race, color, sex, age, national origin, religion, or disability.

Check the block for the racial or ethnic group with

Check the block for the highest level of education

Check the appropriate block:

which you identify:

you have completed (check only one):

Female

White (includes Arabian)

Less than 8th grade

Male

Black (includes Jamaican, Bahamians and

Completed 8th grade

other Caribbeans of African but not Hispanic

Attended high school

or Arabian descent)

High school graduate or equivalent

Please indicate your date of birth:

/ /

Hispanic (includes persons of Mexican,

Attended college and/or associate degree

Puerto Rican, Central or South American or

College graduate

Position applied for:

other Spanish origin or culture)

Attended graduate school

Position number:

Asian & Asian American (includes Pakistanis,

Master’s degree

Indians & Pacific Islanders)

Graduate study beyond master’s

American Indians (includes Alaskans)

requirements

FOR OFFICE USE ONLY

Ph.D. or professional degree

EEO Category:

How did you find out about this employment opportunity?

Newspaper*

State RECRUIT system

Radio/TV*

Agency Bulletin Board

VEC

Other (please specify)

*specify name of newspaper or other media

DHRM Form 10-012A(Rev. 9/03)		Attachment Number
	Supplementary Experience Form
Social Security Number		Position Applied For
Name		Announcement Number
Job Title	Duties:

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Type of business

Immediate supervisor

Title


Salary (start)			(finish)
Dates (mo/yr)			to (mo/yr)
Full-time	Part-time			Hours/week
Job Title
Employer
Address

		Phone

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

DHRM Form 10-012A(Rev 9/03)		Attachment Number
	Supplementary Experience Form
Social Security Number		Position Applied For
Name		Announcement Number
Job Title	Duties:

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Job Title

Employer

Address

Phone

Type of business

Immediate supervisor

Title

Salary (start)

(finish)

Dates (mo/yr)

to (mo/yr)

Full-time

Part-time

Hours/week

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Duties:

Number and titles of employees you supervised Equipment used

Reason for leaving

Your name if different from present

Get Virginia Job Application PDF Form

Fact Name	Description
Governing Form	The Virginia Job Application form is officially known as DHRM Form 10-012, revised in September 2003.
Equal Employment Opportunity	All applicants are provided equal opportunity in employment, regardless of race, color, religion, or other protected characteristics.
Optional Social Security Number	Providing a Social Security number is optional on the application. However, it may be required on other forms prior to employment.
Certification Requirement	Each application must be certified with the current date and an original signature, confirming the truthfulness of the information provided.
Accessibility Accommodations	Applicants needing assistance due to disabilities may contact the agency for confidential help in completing the application.
Legal Employment Eligibility	Under the Immigration Reform and Control Act of 1986, applicants must verify their eligibility for employment in the U.S. upon hiring.

Completing the Virginia Job Application form is straightforward when you follow these steps. Be thorough and accurate while ensuring all required sections are filled out correctly. Gathering necessary information beforehand can help speed up the process.

Start by printing your application in black ink or using a typewriter.
In the section labeled “Position applied for,” write the title of the position you are seeking.
Identify the agency to which you are applying. Only one agency is allowed per application.
If you choose to provide it, fill in your Social Security Number in the specified section.
Provide your full legal name, including your last, first, and middle name.
Fill out your current address, including city, state, and zip code.
Enter your home and business phone numbers, ensuring they are accurate and up-to-date.
Include your email address for further communication.
In the education section, check the highest grade completed and indicate if you have a high school equivalency diploma.
List any post-high school education, including the institution's name, attendance dates, and any degrees received.
Describe your work experience in reverse chronological order. Include job title, employer, duties, and contact information for your immediate supervisor.
Use the space provided to highlight any additional skills, training, or achievements relevant to the position.
Add references who are not related to you, providing their names, addresses, phone numbers, and relationships.
Complete the miscellaneous section by indicating job status and shift preferences.
Answer all questions related to travel and work eligibility, including Selective Service registration and veteran status where applicable.
Provide information regarding any criminal convictions, if applicable.
Indicate your availability to start work and sign the application, certifying its accuracy.
If applicable, answer the demographic questions at the end for record-keeping purposes.
Finally, ensure you send the completed application to the appropriate agency.

What is the purpose of the Virginia Job Application Form?

The Virginia Job Application Form is designed to collect necessary information from applicants seeking employment within the Commonwealth of Virginia agencies. This standardized form ensures that all candidates provide similar information, facilitating a fair evaluation process based on qualifications and experience.

How should the application be completed?

Applicants should complete the Virginia Job Application Form by printing in ink, preferably using black ink, or by typing their responses. It is important to provide accurate and complete information. If an applicant has a disability that prevents them from completing the application, they can contact the agency for assistance.

Is it necessary to include a Social Security number on the application?

Including a Social Security number on the application is optional. An applicant can still be considered for employment without providing this information. However, a Social Security number may be required on other forms before employment begins.

What details should I include under the experience section?

In the experience section, list all paid and relevant volunteer experiences, starting with the most recent. Highlight specific duties, skills, and accomplishments that demonstrate qualifications for the position. Separate different job titles within the same organization, if necessary.

Can I apply for multiple positions using the same application?

No, each application is specific to one position. Candidates must submit separate applications for each position they wish to apply for, clearly indicating the position number and agency on each form.

What happens to my application after submission?

After submission, the application will be reviewed by the hiring agency. They may contact references and previous employers for verification of the information provided. Candidates who qualify will be contacted for interviews or further steps in the hiring process.

Are there any requirements for veterans?

Yes, veterans who received an honorable discharge and meet specific service requirements may have priority consideration. It is important to indicate military service on the application if applicable.

What should I do if I have a felony conviction?

Applicants are required to disclose any felony convictions. If you have a conviction, provide details as requested in the application. Transparency is essential, as not disclosing this information may affect employment eligibility.

What is the deadline for submitting the application?

There is no universal deadline; each agency will specify its own application deadline within the job announcement. It is crucial to submit the application as soon as possible to ensure consideration for the desired position.

Completing the Virginia Job Application form requires careful attention to detail. One common mistake is failing to read the instructions thoroughly before beginning. The application specifies that it should be filled out in ink or typed. Ignoring this guideline could render the application illegible or unprofessional.

Another frequent error is leaving mandatory fields blank. The application contains specific areas that must be completed, such as the position applied for and the applicant’s full legal name. Incomplete applications may not be considered, thereby reducing the chance of receiving an interview.

Some individuals mistakenly fail to include a contact preference. It is critical to provide both home and business phone numbers, as well as an email address. This information is necessary for the employer to reach the applicant for potential follow-up or interviews.

Many applicants overlook the education section. It is essential to check off the highest grade completed and accurately indicate any post-secondary education. Failure to provide this information may lead to misunderstandings about an applicant’s qualifications.

In completing the experience section, applicants often neglect to describe their roles in detail. Simply listing job titles is insufficient. It’s important to highlight relevant skills and responsibilities that align with the job being sought. This provides a clearer picture of one’s qualifications to the hiring manager.

Some people make the mistake of not providing their availability for work. Specifying when one can start is crucial for employers to understand scheduling needs. Leaving this section empty could be interpreted as a lack of interest or commitment.

Additionally, many fail to list three references as requested. It’s advisable to include names, relationships, and contact information for individuals who can vouch for one’s qualifications. Omitting this information may create doubt about the applicant's credibility.

Another common error is not taking the time to double-check for spelling and grammatical errors. Mistakes in the application can create a negative impression and may suggest a lack of attention to detail. Careful proofreading can alleviate such concerns.

Additionally, some applicants do not follow the guideline regarding the submission process. Applications should be sent directly to the agency announcing the vacancy, and knowing the correct submission method is important to ensure timely consideration.

Finally, a significant oversight occurs when applicants fail to sign and date the application. The certification section is vital, as it attests to the accuracy of the information provided. A lack of signature may lead to an application being considered incomplete, thus hampering employment opportunities.

When submitting a Virginia Job Application form, various supplementary documents can enhance your application and provide additional insights to potential employers. Below is a list of common forms often used alongside the Virginia Job Application. Each document serves a unique purpose and contributes to giving a more comprehensive view of your qualifications and readiness for the job.

Supplementary Experience Form: This form allows applicants to provide further details about their work history and relevant experiences. It is particularly useful for those who have held multiple positions or have extensive experience that may not fit within the space allotted on the main application.
Cover Letter: A cover letter introduces you to the employer and highlights your skills and experiences that align with the job position. It personalizes your application and offers a narrative about your professional journey and aspirations.
Resume: A resume lists your professional history, education, and skills in a clear and concise format. Unlike the job application, which requires specific information, a resume allows you to present your qualifications in a tailored way.
Reference List: Providing a separate reference list can facilitate the employer's ability to contact individuals who can vouch for your qualifications. This document should include names, contact information, and relationships to you.
Employment Authorization Form: This form verifies your eligibility to work in the United States. Employers may require proof that you are legally allowed to accept employment before finalizing a hiring decision.
Background Check Authorization: Many employers will conduct background checks during their hiring process. Completing this form allows them to verify your criminal history, creditworthiness, or other relevant background information.
Equal Employment Opportunity (EEO) Form: This form collects demographic data about applicants to ensure compliance with equal opportunity laws. Completing this form is typically voluntary, but it helps employers track their diversity efforts.
Skill Assessment Tests: Some employers may require you to complete assessments related to the skills necessary for the job. These can demonstrate your capabilities or proficiency in specific areas pertinent to the role for which you are applying.

Incorporating these documents can reinforce your application and provide potential employers with a well-rounded picture of your qualifications. It is beneficial to prepare these materials ahead of time to ensure a complete and compelling application process.

Job Resume: Similar to the Virginia Job Application form, a resume provides personal information, work experience, and educational background. Both require details that demonstrate qualifications for a specific position, though a resume may not need to include all references or cover job gaps as extensively.
Federal Employment Application (SF-171): This federal form requires similar information, including personal details, employment history, and education. It emphasizes qualifications for federal jobs, ensuring applicants disclose more detailed work histories compared to the Virginia form.
State Job Application Forms: Each state has its job application forms where applicants submit their education and work history. The similarity lies in the structure and fields required, ensuring compliance with state employment regulations and equal opportunity mandates.
Online Job Application Portals: Many employers now use online platforms that often mirror the layout and questions of traditional job applications. Users fill out personal details, work experience, and education, similar to the Virginia application, but often in a more streamlined digital format.
Internship Application Forms: These forms often share a similar format, asking for details about educational background, skills, and relevant experience. They may cater to entry-level positions like the Virginia application, seeking to assess a candidate's potential.
Volunteer Application Forms: When applying for volunteer positions, applicants often encounter forms that require personal and professional information akin to job applications. Both serve to assess qualifications and fit for the role being applied for.
Contractor Application Forms: For independent contractors, applications may be similar in their request for work experience and skills. These forms typically ask for information pertaining to previous contracts, which mimics the experience section of the Virginia Job Application.

Things to Do

Print the application in black ink or use a typewriter.
Complete all required sections accurately and thoroughly.
Include your full legal name, contact information, and position applied for.
List your work and educational experiences, highlighting relevant skills.
Provide accurate references who are not related to you.

Things to Avoid

Do not leave any required fields blank.
Avoid using pencil or colors other than black ink.
Do not exaggerate or falsify information about your qualifications.
Do not forget to sign and date the application.
Avoid submitting multiple applications for different positions at the same time.

Many misconceptions surround the Virginia Job Application form. These misunderstandings can affect how applicants prepare and submit their applications. Below are seven common misconceptions:

You must include your Social Security number. While the form requests your Social Security number, providing it is optional. Not including it will not prevent consideration for employment.
You can only apply for one position at a time. Applicants may apply for multiple positions by submitting separate applications for each job they are interested in.
Your application will be rejected if it's not filled out perfectly. Small errors are often acceptable. Agencies value complete and honest information more than perfect formatting.
You have to have every job reference available before submitting your application. While it's helpful to have references ready, you can still submit your application and follow up later with this information.
Previous convictions automatically disqualify you from employment. Each application is reviewed on a case-by-case basis. Context and the nature of the offense play a significant role in the evaluation process.
It’s fine to submit a resume instead of filling out the application form. The Virginia Job Application form must be completed and submitted along with any additional documents like a resume.
Employment decisions are only based on work experience. Education, skills, and personal qualifications are also significant factors considered during the hiring process.

Understanding these points can help applicants better prepare their job applications in Virginia.

When filling out and using the Virginia Job Application form, there are several key points to keep in mind:

Complete All Sections: Ensure that every relevant section of the application is filled out thoroughly. Missing information can delay the hiring process or result in disqualification.
Print Clearly: Use black ink or a typewriter to fill out the application. Clear and legible handwriting is essential for avoiding misunderstandings about your information.
Contact Information: Provide accurate phone numbers and email addresses so potential employers can easily reach you for follow-up communications.
References Matter: Select references who can speak positively about your qualifications. Their knowledge of your skills and experiences can significantly impact your chances of getting hired.

Salary (start)

Dates (mo/yr)

to (mo/yr)

Hours/week

Ucc Transcripts - You can choose to hold your transcript for recording grades or graduation.

Form 65 - It includes identification details for the licensed removalist, including their name and license number.