The Virginia Job Application Form, officially known as DHRM Form 10-012 (Rev. 9/03), serves as a comprehensive tool for candidates aiming to secure employment within various agencies of the Commonwealth of Virginia. Emphasizing inclusivity and equal opportunity, the form requires detailed information from applicants regarding their education, experience, and skills, catering to a broad spectrum of job positions. Its structure ensures that individuals are evaluated fairly, without regard to race, color, religion, political affiliation, national origin, disability, marital status, gender, or age. To better navigate your career aspirations in Virginia, familiarize yourself with this application and take the first step by clicking the button below.
The Commonwealth of Virginia takes pride in ensuring equal employment opportunities through the DHRM Form 10-012, a comprehensive application designed for job seekers aiming to enter public service. This form not only facilitates the assessment of a candidate's eligibility and qualifications for a given position but also underscores the state's commitment to non-discrimination based on race, color, religion, and other protected classes. Applicants are encouraged to detail their educational background, work experience, and any licenses or certifications that qualify them for the position, providing a thorough overview of their capabilities. Notably, the form includes provisions for those with disabilities, offering assistance to ensure all candidates can apply with ease. Additionally, it addresses legal compliance issues such as eligibility to work in the United States, adherence to the Selective Service registration requirement, and veteran status, ensuring all necessary legal boxes are ticked off. With spaces for references and miscellaneous details like shift and job status preferences, the Virginia Job Application form is a key step in the Commonwealth's hiring process, reflecting efforts to maintain a diverse and inclusive workforce.
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.
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
2
3
4
5
Name and Location of Institution
Hrs
Degree
Major or Specialty
Minor
Dates Attended
Received
2.
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?
Job Title
Duties:
Employer
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
Number and titles of employees you supervised Equipment used
c. Job Title
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
Relationship
12.MISCELLANEOUS
Check which shift you will accept:
Day
Evening
Night
Rotating
Weekends
Specify shift hours
Check which job status you will accept:
Part-time (specify)
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?
No.
g.
For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States?
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
Announcement Number
DHRM Form 10-012A(Rev 9/03)
Filling out the Virginia Job Application form requires attention to detail and accuracy to ensure all relevant information is conveyed effectively. This guide outlines the steps to complete the form, ensuring candidates present their qualifications and experience comprehensively. Once submitted, the application will be reviewed for potential employment opportunities within the Commonwealth of Virginia, considering the applicant's skills, experience, and educational background against the requirements of the position applied for.
With the form duly filled, reviewing it for accuracy before submission is critical. The next step involves sending this application directly to the agency advertising the vacancy, as indicated on the job announcement. Careful adherence to the instructions ensures that your application will be successfully processed for consideration.
When completing the Virginia Job Application form, applicants need to provide detailed information that helps the hiring agency assess their qualifications. Required information includes:
No, providing your Social Security Number (SSV) on the Virginia Job Application form is optional. Failure to include your SSN will not prohibit employment consideration. However, it's important to note that your SSN may be required on other documents as part of the employment process.
Individuals with disabilities that prevent them from completing the application can request confidential assistance. This support is available by calling the agency to which they are applying directly. The aim is to ensure that all applicants have an equal opportunity to apply for positions within the Commonwealth of Virginia.
Yes, you can and should list volunteer experience on your application, especially if it is relevant to the position you are applying for. Volunteer experience should be detailed similarly to paid experience, highlighting the role, responsibilities, and skills developed during the volunteer positions. Be sure to include the organization's name, your title, dates of involvement, and any notable achievements or contributions.
If you have more experience than the space provided on the application allows, you should use Supplementary Experience Form(s) for additional space. This ensures you can provide comprehensive details about your professional background, skills, and qualifications relevant to the position you are applying for. Remember, the aim is to give the hiring agency a clear, complete picture of your suitability for the job.
Filling out the Virginia Job Application form requires attention to detail. Many applicants, however, make common mistakes that may impact their chances of securing employment. Knowing what these errors are can significantly improve the quality of your application.
Avoiding these mistakes can enhance your application, making it stand out to potential employers in the Commonwealth of Virginia. Each detail you provide contributes to the overall impression you make, so it's important to review your application thoroughly before submission.
When applying for a job, especially within the state of Virginia, the application form is just the starting point. Various other forms and documents are often needed to fully complete the application process. These span from supplementary forms highlighting more specific experiences to various certificates and personal identification documents, all aimed at providing a comprehensive picture of the applicant’s qualifications, identity, and legal eligibility for employment.
In combination, these documents play a crucial role in the hiring process, allowing employers to gain a holistic understanding of each candidate. By providing a detailed personal and professional background, candidates can ensure they are accurately representing their qualifications and standing out to potential employers.
The Virginia Job Application form is similar to other standardized employment applications used across various state departments. Here's how:
Federal Employment Application: Just like the Virginia Job Application form, the Federal Employment Application seeks detailed information on an applicant's education and employment history. Both forms ask for positions applied for, full legal names, contact information, educational background, work experience, and references. However, the Federal form often requires more specific details on federal service and may include questions about military service, federal status, and security clearance, reflecting the distinct requirements of federal employment.
Generic Job Application Templates: These templates, found online or in print format, share similarities with the Virginia Job Application form in their structure and the type of information requested. Both include fields for personal information, educational background, specific job experience, and references. The primary difference lies in customization; while the Virginia form is tailored for state employment, including sections about eligibility for work under the laws of the Commonwealth of Virginia, generic templates are designed to be broadly applicable to a variety of jobs and employers.
Academic Institution Employment Applications: Applications for positions at colleges, universities, and other educational institutions often mirror the Virginia Job Application form in sections asking for academic history, including degrees earned, institutions attended, and fields of study. Both recognize the importance of educational background in evaluating candidates. However, academic applications may delve deeper into specific academic, research, and publication histories relevant to the educational sector, which is not as emphasized in the Virginia form.
Corporate Job Applications: Many corporate application forms share the Virginia Job Application form's focus on previous employment history and educational background. Both types of applications request detailed employment history, including job titles, duties, employment dates, and reasons for leaving previous positions. The major difference often lies in the corporate form's additional emphasis on specific skill sets, professional certifications, and sometimes a more detailed section on achievements and awards that are particularly relevant to the corporate sector.
When filling out the Virginia Job Application form, it's crucial to approach the process thoughtfully and methodically. To help, here are some dos and don'ts that will guide you through the process.
When it comes to the Virginia Job Application form, there are several common misconceptions that applicants might have. Understanding these can help ensure your application is completed accurately and effectively. Here are four misconceptions and the truths behind them:
While the application form asks for your Social Security Number (SSN), it is important to note that providing your SSN is optional at this stage. The form clearly states that failure to submit your SSN will not prohibit employment consideration. However, be aware that your SSN may be required on other forms prior to your employment.
Although it's vital to provide comprehensive and accurate information, section 3 regarding your SSN is optional, and you can also request confidential assistance if you have specific disabilities that prevent you from completing the application. This shows that the Commonwealth of Virginia aims to be inclusive and accommodate all applicants.
The Virginia Job Application form encourages applicants to describe all paid, military, and applicable voluntary experience. This broad definition allows you to highlight a range of experiences that demonstrate your qualifications for the position, not just traditional employment. Remember, different roles within the same organization should be listed as separate items to showcase your breadth of experience.
While the form requires disclosure of any law violations, including convictions, this does not mean an automatic disqualification. The commonwealth is interested in understanding your qualifications and background comprehensively. It's crucial to be honest, as all information on the application is subject to verification. Each case is considered on its own merits, taking into account the nature of the conviction and its relevance to the job you're applying for.
Understanding these misconceptions can help applicants approach the Virginia Job Application form with clarity and confidence, ensuring that all information provided is accurate and effectively communicates their qualifications and suitability for the desired position.
When applying for employment through the Virginia Job Application form, it is essential to understand and adhere to the instructions and requirements to ensure your application is considered properly. Here are key takeaways to assist applicants in navigating the form effectively:
Each section of the application is designed to collect information necessary for assessing your qualifications and fit for the job. Paying close attention to the details and providing complete and honest information will help ensure your application is processed smoothly and increases your chances of employment with the Commonwealth of Virginia.
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