Unc dental residents | veterans affairs

ITEMS LISTED BELOW MUST BE RECEIVED BY THE FOLLOWING DENTAL POINTS OF CONTACT (POC) AT THE DURHAM VAHCS NLT APRIL 12, 2019:    Alicia Tsai, Dental Program Coordinator, , Email 

[email protected] Yonika Edwards-Rogers, , Email: [email protected] Aretha Best, , Email: [email protected] MAILING ADDRESS: Durham VA Medical Center Dental Service (160) Attn:

Alicia Tsai 508 Fulton Street Durham, North Carolina 27705 PLEASE DOWNLOAD EACH DOCUMENT TO YOUR COMPUTER IN ORDER TO EDIT AND INPUT YOUR INFORMATION.  AM I ELIGIBLE - Download and complete

this checklist to be sure you meet all eligibility requirements to train at VA facilities. (PDF) APPOINTMENT LETTER - Review, sign bottom and return this document to your DVAHCS POC.

FINGERPRINT REQUEST - Complete all boxes and return to your DVAHCS POC.  VA FORM 10-2850D APPLICATION FOR HEALTH PROFESSIONS TRAINEE Dated Nov 2011 (Please follow the instructions above)

(PDF) FORM (OF) 306, DECLARATION FOR FEDERAL EMPLOYMENT FORM (OF) 306, DECLARATION FOR FEDERAL EMPLOYMENT  (PDF) (Provide (FIRST, FULL MIDDLE, & LAST NAME). If you don’t have a middle

name, indicate “No Middle Name”. If you have only initials in your name, provide them and indicate “Initial only”.  (Sign page 3.  Return this document to your DVAHCS POC)   SELECTIVE

SERVICE SYSTEM: * Male trainees are required to register with the Selective Service System, print proof of registration or, if not registered, apply for a status information letter (SIL).

The SIL denotes one’s requirement for registration, and, if applicable, exemption from the registration requirement. (PROVIDE A COPY OF THIS DOCUMENTATION TO YOUR DVAHCS POC) * Federal law

requires that most males living in the US between the ages of 18 and 26 register with the Selective Service System. This includes individuals who are US citizens, non-US citizens and dual

nationals, regardless of their immigration status. Male for this purpose is defined as those individuals born male on their birth certificate regardless of current gender. Only male, non-US

citizens on a student or visitor visa are exempt from registration. * Complete a request form for a status information letter at the govwebsite. You will have to describe, in detail, the

circumstances you believe prevented you from registering and provide copies of documents showing any periods when you were hospitalized, institutionalized, or incarcerated occurring between

your 18th and 26th birthdays. If you are a non-citizen, you may be required to provide documents that show when you entered the United States. Please include your name, social security

number, date of birth, and return address. * Males required to register, but who fail to do so by their 26th birthday, are BARRED FROM ANY POSITION IN ANY EXECUTIVE AGENCY. * FOR MEN BORN

AFTER 1960: A status information letter from the Selective Service System states the facts:  Whether or not the man is registered; whether or not the man should have registered or if he is

exempt. * If you did not register with Selective Service and are now a man 26 years old or older, you may be ineligible for certain federal or state programs and benefits, including U.S.

citizenship. Some agencies may ask you to provide an official response from the Selective Service indicating if you were or were not required to register. DETERMINATION & CERTIFICATION

OF ENGLISH LANGUAGE PROFICIENCY (Fill in your information. Return this document to your DVAHCS POC.) (PDF) RANDOM DRUG TESTING NOTIFICATION AND ACKNOWLEDGEMENT (Fill in your information and

return this document to your DVAHCS POC.) (PDF)  FNGRERPRINT PREP SHEET (Complete all boxes and return to your DVAHCS POC.)   (PDF)    COURTESY FINGERPRINTING: If you have a nearby VA, you

can begin the fingerprint clearance process prior to arriving in Durham (Present the DVAMC Appointment letter and the Courtesy fingerprints document to your Local VA Facility.  (PDF) NON-US

CITIZEN REQUEST MEMO (If applicable) (Only to be completed by non-US Citizens.  Fill in highlighted blocks through item 3 and turn in to your DVAHCS POC. Include a copy of VISA and passport)

  (DOCX)  VHA MANDATORY TRAINING FOR TRAINEES (MTT): MUST BE COMPLETED PRIOR TO SUBMITTING PAPERWORK ON APRIL 12, 2019 Go to TMS website-Self register and complete MTT. You need the

following information to complete self-registration: VA Location: DUR DVAHCS POC: Yonika Edwards-Rogers DVAHCS POC email: [email protected] DVAHCS POC telephone #:  175070 PROVIDE YOUR

POC A COPY OF YOUR COURSE COMPLETION TO your DVAHCS POC   *Trainees who previously had TMS accounts: CHANGE YOUR EMAIL ACCOUNTS IN TMS TO ENSURE YOU CAN ACCESS THE EMAIL ACCOUNT LISTED.  IF

YOU PREVIOUSLY HAD A TMS ACCOUNT AND CAN NO LONGER ACCESS IT, PLEASE CALL THE DURHAM VA TMS DOMAIN MANAGERS AT 919.286.0411 EXT 176909 FOR ASSISTANCE.  LOST, STOLEN, DESTROYED, OR DAMAGED

PIV BADGE (If previously issued a PIV badge that has been lost, stolen, or destroyed, please fill out the PIV Memo through your signature line. Return document your DVAHCS POC.)  (PDF)  

IDENTIFICATION (Bring two original/current ID’s from the List of Acceptable Forms of ID to your DVAMC orientation/appointment. School ID will not suffice.)  (PDF)  STANDARD FORM 61

APPOINTMENT AFFIDAVITS Revised August 2002 Do not sign or get notarized, fill in the top portion using Health Professions trainee as the position in which appointed; Department: VA; Bureau

or division: VHA; Place of Employment: DVAHCS. (PDF)  LOST, STOLEN, DESTROYED, OR DAMAGED PIV BADGE (If previously issued a PIV badge that has been lost, stolen, or destroyed, please fill

out the PIV Memo through your signature line. Return document your DVAHCS POC.)  (PDF) CURRENT PIV BADGE HOLDERS (If you have a PIV badge from another VA facility, please advise your DVAHCS

POC)   IDENTIFICATION (Bring two original/current ID’s from the List of Acceptable Forms of ID to your DVAMC orientation/appointment. School ID will not suffice.)  (PDF) NPI NUMBER (Print

Page with NPI Number. Send page to your DVAHCS POC)