Homepage / Fill in a Valid Dca 25A 1 Template
Jump Links

Completing the DCA 25A 1 form is a crucial step for individuals seeking licensure as veterinarians in California. This document outlines the application process, provides a clear list of required fees, and outlines the vital information that prospective applicants must disclose. From personal details, including your name and social security number, to educational history and previous licenses, every section is essential for determining eligibility. The form also includes sections that address any past disciplinary proceedings or criminal convictions, ensuring that ethical standards remain a priority in the veterinary field. Additional considerations exist for spouses and domestic partners of active military personnel, allowing for expedited processing under specific conditions. Applicants must also verify the authenticity of their submission through a certification signature, emphasizing the significance of honesty in the licensing process. Understanding the various components of the DCA 25A 1 form can greatly streamline your path to becoming a licensed veterinarian 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)

File Breakdown

Fact Name Fact Detail
Governing Agency The form is issued by the Veterinary Medical Board of California, under the Business, Consumer Services, and Housing Agency.
Application Fees There are three application fees: $125 for Application Evaluation, $200 for State Board Examination, and $100 for California Veterinary Law Examination.
Social Security Requirement Applicants must provide a U.S. Social Security number as it is mandatory for licensure, per Section 30 of the Business and Professions Code.
Physical Description Applicants must provide physical characteristics including hair color, height, eye color, and weight on the form.
Education Information Applicants must enter details about their college or university education including the degree received and graduation date.
Disciplinary Action Disclosure Applicants must disclose any past disciplinary proceedings against any veterinary practice licenses they hold.
Criminal History Applicants must disclose any misdemeanor or felony convictions other than minor traffic violations.
Expedited Processing Spouses or domestic partners of active duty military personnel may qualify for expedited application processing.

Guide to Using Dca 25A 1

To proceed with filling out the DCA 25A 1 form, follow the steps outlined below carefully to ensure all required information is provided accurately. This form is essential for applying for a veterinary license, and complete and accurate details will facilitate the processing of your application.

  1. Review the application type and associated fees. Check the appropriate boxes indicating the fees you are paying, including the application evaluation fee, state board examination fee, and California veterinary law examination fee. Total your fees and make a check or money order payable to “VMB”.
  2. Provide your current mailing address, including city, state, zip code, and country, in the APPLICANT INFORMATION section. Fill in your full name, birthdate, telephone number, email address, and social security number.
  3. Indicate your physical description: hair color, height, eye color, and weight. Attach your passport-sized photo to the indicated area and write the date the photo was taken.
  4. Complete the EDUCATION INFORMATION section by listing your college or university, dates of attendance, courses pursued, graduation date, and degree received.
  5. List any states or provinces where you are licensed as a veterinarian. Include the registration number, date issued, and whether the license was obtained by examination or credentials.
  6. Answer whether you have previously applied to take the veterinary examination in California by checking 'Yes' or 'No'.
  7. Respond to the disciplinary action question. Check 'Yes' or 'No' and provide a detailed explanation if you answer 'Yes'. Include specifics about the date and state of the discipline.
  8. Indicate if you have ever been convicted of any offense other than minor traffic violations. Again, check 'Yes' or 'No' and include a detailed explanation if applicable.
  9. If applicable, indicate if you are a spouse or domestic partner of active-duty military personnel for expedited application processing.
  10. Finally, read the certification statement carefully. Sign and date the form at the bottom to certify the accuracy of the information provided.

Get Answers on Dca 25A 1

What is the DCA 25A 1 form?

The DCA 25A 1 form is an application for individuals seeking licensure to practice veterinary medicine in California. It includes sections for personal details, educational background, and any legal or disciplinary history related to veterinary practice.

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

Applicants must pay the following fees:

  • $125.00 for the Application Evaluation Fee.
  • $200.00 for the State Board Examination Fee.
  • $100.00 for the California Veterinary Law Examination Fee, if applicable.

All fees must be paid by check or money order made out to the Veterinary Medical Board (VMB).

Who needs to fill out this form?

The form must be completed by individuals applying for a veterinary license in California. This includes both new applicants and those who have previously applied for examination.

Is providing a Social Security number mandatory?

Yes, it is mandatory to provide a United States Social Security number. This is necessary for tax enforcement purposes and compliance with legal requirements regarding child support payments.

What kind of disciplinary history must I disclose?

Applicants must disclose any disciplinary proceedings against any veterinary license. This includes revocation, suspension, probation, or voluntary surrender. Be detailed in your explanation and include dates and states where actions occurred.

What should I include if I have a criminal conviction?

List all misdemeanor and felony convictions, regardless of their age. This includes cases that were set aside or dismissed. Traffic violations involving DUI or providing false information must also be reported.

What is the expedited application processing for military spouses and domestic partners?

Spouses or domestic partners of active duty military personnel may qualify for expedited processing. Applicants must provide proof of their relationship and hold a current veterinary license from another state.

Can I submit the form if I have not completed my education?

No, you need to provide information about your education, including the dates of attendance and the degree received. Completing your veterinary education is necessary to qualify for licensure.

What happens if I provide false information on the application?

Providing false or incomplete information can lead to denial of your application or revocation of your veterinary license. It is crucial to ensure all information is accurate and complete.

Where do I send my completed application?

Submit your completed form, along with any supporting documents and fees, to:

Veterinary Medical Board
1747 N. Market Blvd., Suite 230
Sacramento, CA 95834

Common mistakes

Filling out the DCA 25A 1 form can be straightforward, but many applicants make common mistakes that can lead to delays or even denials in their application process. Understanding these pitfalls is crucial.

One frequent error is failing to select the appropriate application fees. The form requires applicants to check the fees they are paying, but some people forget to indicate that they've included the application evaluation fee, examination fees, or other applicable fees. This oversight can lead to their application being returned for incomplete payment.

Another common mistake occurs in the applicant information section. Individuals sometimes omit their social security number or provide one from a foreign country. The form explicitly states that only a U.S. social security number will be accepted. Leaving this blank or providing incorrect information can cause significant delays.

Errors often pop up in the education section as well. Applicants may forget to list all relevant educational institutions attended or include incorrect graduation dates. Any discrepancies or incomplete information can raise red flags, requiring additional verification that extends the processing time.

Providing incorrect personal details is yet another mistake. This could be anything from misspelled names to inaccurate contact information. If the Veterinary Medical Board cannot reach you regarding your application status or any issues, the processing of your application could be adversely affected.

People sometimes overlook the physical description portion of the form, leaving it incomplete or failing to attach the required passport-sized photo. Including a photo that does not meet specifications can result in a request for resubmission, further delaying the application process.

It’s important not to rush through the disciplinary action disclosure. Some applicants may fail to report any past disciplinary proceedings against themselves, even if they believe those matters were settled or irrelevant. Omitting information can appear as if the applicant is being deceptive, which can lead to denial of the application.

Another area for potential mistakes involves criminal history disclosures. Applicants often misunderstand the requirement to report all convictions, no matter how minor. Many individuals mistakenly assume that older or irrelevant offenses do not need to be cited. This misunderstanding can lead to a belief that an application is fine when it is actually incomplete.

A less obvious mistake is not reading the notes regarding the certification section carefully. Applicants often do not realize the legal implications of their signatures. This form serves as a legal document, and failure to report new offenses or updates could have serious repercussions.

Finally, individuals sometimes submit their applications without double-checking their work. Simple typos and omissions can lead to misunderstandings and processing delays. Taking the time to proofread your application can save you from unnecessary complications.

Documents used along the form

The DCA 25A 1 form is a significant document for those seeking veterinary licensure in California. However, applicants often need to complete additional forms and documents as part of the application process. Below is a list of forms commonly used alongside the DCA 25A 1 form, along with brief descriptions of each.

  • DCA 25A 2 Form: This is a supplemental application form that provides additional information regarding the applicant’s education and training history.
  • Verification of Licensure: This document verifies an applicant's previous veterinary licenses from other states or countries, confirming their educational credentials and professional history.
  • Application for Waiver: This form may be submitted by applicants seeking exemption from certain licensing requirements based on their unique circumstances.
  • Criminal History Disclosure Form: Applicants must disclose any criminal convictions. This document details the nature of the offenses, which is necessary for the board’s review process.
  • Background Check Authorization: Before finalizing the licensure, applicants must authorize a background check to verify their professional history and any criminal records.
  • Affidavit of Experience: This document outlines the applicant's experience in veterinary practice and may be required for those seeking to demonstrate practical competencies.
  • Photo Identification: A recent photograph is required, which helps identify the applicant during the examination and licensing process.
  • Proof of Continuing Education: Candidates must show proof of any continuing education courses successfully completed, which informs the board of their commitment to professional growth.
  • Military Spouse Application: For military spouses, this form provides alternate pathways and benefits available to those applicants married to active-duty service members.
  • Submission of Exam Results: After completing the necessary examinations, candidates must submit their results to prove compliance with examination requirements.

These forms and documents contribute to the overall application process for obtaining a veterinary license in California. Being informed about these requirements can help streamline your application and avoid any delays. Ensure that all relevant forms are completed accurately and submitted in a timely manner to increase the chances of a successful application.

Similar forms

  • Veterinary Medical License Application (Form VMB 25A): This form serves a similar purpose as the DCA 25A 1 form by facilitating the process for individuals seeking to obtain a veterinary license. It requires personal, educational, and professional information necessary for evaluation.

  • VMB Applicant History Form: Like the DCA 25A 1, this document gathers detailed information on previous licenses held, providing the Veterinary Medical Board with insight into the applicant's background and practice history.

  • State Veterinary Board Examination Application: This form is similar as it requires candidates to apply for the examination necessary to practice veterinary medicine. It also covers similar types of fee structures and personal disclosures.

  • Background Check Authorization Form: Similar to DCA 25A 1, this document is used to authorize background checks for potential disciplinary actions or criminal convictions that may impact licensure eligibility.

  • Professional Practice Agreement Form: This form parallels the DCA 25A 1 as it may require submission during the licensure process, detailing agreements between the veterinarian and their practice or employer regarding standards of care and responsibilities.

  • Continuing Education Report Form: Similar in that it documents ongoing professional development, this form ensures that licensed veterinarians meet state educational requirements after obtaining licensure.

  • Statement of Disclosure Form: Like the DCA 25A 1, this document gathers information regarding any perceived conflicts of interest or relevant legal issues that might affect an applicant's eligibility for licensure.

  • Application for Reciprocity: This form is akin to the DCA 25A 1 as it allows veterinarians licensed in other states to apply for licensure in California, ensuring necessary information is provided for evaluation.

  • License Renewal Application: Similar in function, this form is used by current license holders to renew their veterinary licenses, typically requiring updated personal and professional information.

Dos and Don'ts

Filling out the DCA 25A 1 form requires attention to detail and adherence to guidelines. Here are four important dos and don’ts to consider:

  • Do check your fees carefully before submitting. Ensure you pay the correct amount based on the application type.
  • Do provide your U.S. Social Security number without exception. This is mandatory and will be used solely for tax enforcement and compliance purposes.
  • Do include accurate and comprehensive information regarding any previous disciplinary actions or convictions. Transparency is essential.
  • Do sign and date the application to certify that all provided information is accurate and complete.
  • Don’t leave any fields blank. All items in the application are mandatory. Incomplete submissions will delay the process.
  • Don’t ignore the necessity of attaching a recent photograph as specified. A correct photo format is essential for identification purposes.
  • Don’t submit your application without reviewing it for errors. Double-check for spelling mistakes or incorrect details.
  • Don’t underestimate the importance of providing a detailed explanation if required about disciplinary actions or convictions. Failure to do so can jeopardize your application.

Misconceptions

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

This form is not limited to first-time applicants. It also accommodates individuals who may have previously applied or are looking to reinstate their previous credentials. Any veterinarian seeking licensure in California must use this form.

Misconception 2: Submission of the DCA 25A 1 form guarantees automatic licensure.

Filling out this application does not ensure that a license will be granted. Each application is evaluated based on various criteria, including educational background, disciplinary history, and any legal issues that may arise.

Misconception 3: It is optional to provide a Social Security number on this form.

Providing a U.S. Social Security number is mandatory for this application. This number is used strictly for tax enforcement and compliance purposes, as mentioned in the instructions on the form.

Misconception 4: The application process is quick and does not require detailed explanations.

Applicants must provide comprehensive information, especially concerning any past disciplinary actions or criminal convictions. Failing to supply detailed explanations can lead to complications down the line.

Key takeaways

Completing the DCA 25A 1 form is a crucial step for individuals seeking licensure in veterinary medicine within California. Here are some key takeaways to consider:

  1. Ensure all sections of the form are filled out completely. Incomplete applications can be deemed invalid.
  2. Pay particular attention to the application fees, including the $125 application evaluation fee and additional fees as necessary.
  3. Provide your U.S. social security number; it is mandatory for processing and future tax enforcement purposes.
  4. A passport-sized photo is required, so be prepared with an appropriate photo attached to your application.
  5. Disclose any previous disciplinary actions against your veterinary license. Full disclosure is essential to avoid future complications.
  6. If applicable, include any felony or misdemeanor convictions beyond minor traffic violations, as these may impact your application.
  7. If you are a spouse or domestic partner of active-duty military personnel, you may qualify for expedited processing; provide the necessary proof.
  8. Sign and date the certification section to affirm that all information provided is accurate and truthful; false statements can lead to denial or revocation.
  9. Retain copies of your completed application and supporting documents for your records; these may be necessary for your future reference.
  10. Be aware that the information provided will be used to assess your eligibility for the veterinary exam and licensure.

By following these guidelines, applicants can navigate the DCA 25A 1 form process more effectively, ensuring a smoother path to obtaining a veterinary license in California.