Va central Office Optometry Professional Standards Board Checklist



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Date21.06.2018
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VA Central Office Optometry Professional Standards Board Checklist


Name: ______________________________ Date: ____________________
Appointment or Conversion to Full-Time Permanent
Cover Letter with Request Information (including full-time, or part-time or full-time permanent probationary, and requested grade/step) and Human Resources Point of Contact
Completed Application for Physicians, Dentists, Podiatrists, Optometrists and

Chiropractors (VA Form 10-2850)


Curriculum Vitae
Evidence of Current Licensure
Clinical Privileges (proposed)
Evidence of Successful Completion of National Board of Examiners in Optometry (NBEO) Examinations
Evidence of Successful Completion of Doctor of Optometry (OD) degree from an Accreditation Council on Optometric Education (ACOE) accredited School or College of Optometry
Evidence of Successful Completion of an ACOE accredited Residency program
Evidence of Faculty Appointment
Evidence of 2 years optometric practice or its equivalent. One year of approved residency training or its creditable equivalent acceptable to the ACOE of the American Optometric Association is acceptable in lieu of 2 years of practice, and meet the Full grade qualification standards. (For Full Grade)
Evidence of 4 years optometric practice or its equivalent. One year of approved residency training or its creditable equivalent acceptable to the ACOE of the American Optometric Association is acceptable in lieu of 2 years of practice, and meet the Intermediate grade qualification standards. (For Intermediate Grade)
Evidence of 4 years optometric practice or its equivalent. One year of approved residency training or its creditable equivalent acceptable to the ACOE of the American Optometric Association is acceptable in lieu of 2 years of practice, meet qualification standards requirements for the next lower grade level, and the grade being requested (For Senior and Chief Grade)

Promotion
Cover Letter with Request Information and Human Resources Point of Contact
Standard Form 50-B (SF 50-B) showing Employee’s Anniversary Date of Grade
Curriculum Vitae (updated)
Latest SF 50-B
Last 3 Proficiency Reports (or what is available)
Last 3 Board Action Reports (or what is available) approved by Facility Director
Recommendation from the Rating Official
Evidence of Successful Completion of NBEO Examinations (for Intermediate Grade or higher requests)
Full Grade: Two (2) years optometric practice or its equivalent. One year of approved residency training or its creditable equivalent acceptable to the ACOE of the American Optometric Association is acceptable in lieu of 2 years of practice, and meet the qualification standards requirements.
*Intermediate Grade, **Senior Grade or **Chief Grade: Four (4) years of optometric practice or its equivalent. One year of approved residency training or its creditable equivalent acceptable to the ACOE of the American Optometric Association is acceptable in lieu of 2 years of practice. *Meet qualification standards requirements. **Meet qualification standards requirements for the next lower grade level, and the grade being requested.
Special Advancement for Achievement/Performance
Cover Letter with Request Information and Human Resources Point of Contact
SF 50-B showing Employee’s Anniversary Date of Grade
Curriculum Vitae (updated)
Latest SF 50-B
Last 3 Proficiency Reports (or what is available)
Last 3 Board Action Reports (or what is available) approved by Facility Director
Recommendation from the Rating Official
3/13


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