VA Form VA0120: VA Police Officer Pre-Employment Screening Checklist

1. 1

   Enter the facility and applicant

   Fill in the facility location, FBI ORI and Part I. Page 2 repeats Part I, marked "From page 1".

2. 2

   Run the record checks

   The Chief of Police checks the criminal record repository and the National Crime Information Center, marks the results and signs and dates the Part II certification.

3. 3

   Call past employers

   Human Resources Management completes the Part III questions for each employer. The form says all indicative negative responses are documented in Part V. The inquirer signs with their title and the date.

4. 4

   Record the basis for qualification

   Mark experience, substitute education or military service in Part IV. When military service is used, the form says the specialty is verified by review of DD Form 214 or another official document.

5. 5

   Certify and send it

   Add any Part V statements and the verifier's signature. The PDF has buttons to submit by email to local HR, to print the form for shipment and to submit via email to LETC.

• 

  4676a

  Employee Supplemental Qualifications Statement

  11 fields, 3 pages

• 

  VA0710

  Authorization for Release of Information—Protected Under the Fair Credit Reporting Act (Title 15, Section 1681)

  6 fields, 1 page

• 

  VA4939

  Complaint of Employment Discrimination

  38 fields, 2 pages

• The Chief of Police

  Part II, Arrest Record Checks and Certification, is marked "By Chief of Police" with the purpose code Criminal Justice Employment. The Chief of Police signs a certification about the candidate's experience.

• Human Resources Management

  Parts III and IV each say Human Resources Management must complete the section: the telephone checks with past employers and the basis for qualification.

• The HR verifier

  At the end of page 2, Human Resources Management Service certifies that the applicant is suitable and meets current qualification standards for the GS-083 Police Officer series. The verifier signs with their title and the date.

• Past employers contacted by phone

  Part III records answers from a named contact at each employer, such as the applicant's position, dates of employment, quality of work, honesty and character, and whether the employer would rehire the applicant.

• The applicant is the subject

  Part I lists the police officer applicant's name, Social Security number, date of birth and sex, on page 1 and again on page 2. The checklist is about the applicant rather than filed by the applicant.

The form labels each part with the VA office that fills it in.

• Official VA form page

  The agency’s own page for Form VA0120.

• Blank PDF

  The official blank form, to print or fill by hand.

  Download blank PDF

No tool matches that search.