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Va form 21 4140 1 2005-2026
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- Click ‘Get Form’ to open it in the editor.
- 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.
- Proceed to question 10 regarding your employment status over the past 12 months. If employed, complete Section II; if not, move to Section III.
- 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.
- If you have not been employed in the last year, complete Section III by certifying your unemployment status and signing the form.
- Review all entries for accuracy before saving or exporting your completed form for submission.
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21 4140
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