The assessment part of the questionnaire includes questions about basic requirements and job elements related to this position. NOTE: If you are faxing your application and filling out the 1203-FX form, you may notice that the numbering restarts here with number one. When entering your responses on the 1203-FX form, please continue to enter your responses on the next available number within this section of the form.
: Select the appropriate answer to the following questions based on your level of education and experience that demonstrates you meet the basic requirements for this position. Please answer "YES" or "NO" to the following questions.
The following section is used to assign your referral status. FAILURE TO CLAIM AT LEAST ONE ELIGIBILITY WILL RESULT IN AN INELIGIBLE RATING. Applicants are responsible for claiming their appropriate eligibility/eligibilities. We are not responsible for erroneous eligibilities entered.A- Yes
1. I am currently employed with the Department of Veterans Affairs.
2. I am not currently employed with the Department of Veterans Affairs.
3. I am a United States citizen.
4. I am proficient in spoken and written English.
5. I have a doctoral degree in psychology from a graduate program in psychology by the American Psychological Association (APA). The specialty area of the degree must be consistent with the assignment for which the applicant is employee. AND, have successfully completed a professional psychology internship training program that has been accredited by APA. Exceptions: (1) new VHA psychology internship programs that are in the process of applying for APA accreditation are acceptable in fulfillment of the internship requirement, provided that such programs were sanctioned by the HVA Central Office Program Director for Psychology and the VHA Central Office of Academic Affiliations at the time the individual was an intern and (2) VHA facilities who offered full one-year pre-doctoral internships prior to PL 96-151 (pre-1979) are considered to be acceptable in fulfillment of the internship requirement. COPIES OF UNOFFICIAL TRANSCRIPTS REQUIRED
6. I hold a full, current, and unrestricted license to practice psychology at the doctoral level in a State, Territory, Commonwealth of the United States (e.g., Puerto Rico), or the District of Columbia. Exception - The Secretary may waive the requirement of licensure for an individual psychologist for a period not to exceed 2 years from the date of employment on the condition that such a psychologist provide care only under the supervision of a psychologist who is so licensed. Non-licensed psychologists who otherwise meet the eligibility requirements may be given a temporary appointment as a graduate psychologist under the authority of 38 U.S.C. 7405(a) (1) (D). Failure to obtain licensure during that period is justification for termination of the temporary appointment. This may result in termination of employment.
RESUME REMINDER - Your resume must include the following information for each job listed:
• Job title
• Duties (be as detailed as possible)
• Month & year start/end dates (e.g., June 2007 to April 2011)
• Full-time or part-time status (include average hours worked per week)
TRANSCRIPTS REMINDER - You must submit a copy of your transcripts (official or unofficial) or an appropriate course listing with your application.
7. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C 1001); my eligibilities may be cancelled, I may be denied an appointment, or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated. I understand that responding "No" to this item will result in my not being considered for this position.A. Yes, I certify that the information provided in this questionnaire is true, correct and provided in good faith, and I understand the information provided above.