Va form 21 4140 1 2005-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I, where you will enter your identification information. Fill in your name, date of birth, social security number, and contact details clearly.
3. Proceed to question 10 regarding your employment status over the past 12 months. If employed, complete Section II; if not, move to Section III.
4. In Section II, list all employers from the past year. Include their names, addresses, type of work performed, hours worked per week, and any time lost due to illness.
5. If you have not been employed in the last year, complete Section III by certifying your unemployment status and signing the form.
6. Review all entries for accuracy before saving or exporting your completed form for submission.

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