Durham VA Health Care System
Congratulations on your new appointment as a resident at the Durham VA Health Care System. We are excited to have you on the team. We hope your time with us is both exciting and motivating. Below you will find links to the paperwork required for Duke Residents. Complete, print out, sign and turn in all paperwork together to Program POC. Again, congratulations and welcome to the team.
Items listed below must be received by your Durham VA Health Care System (DVAHCS) Point of Contact (POC) by due date - April 12, 2019.
Do not send completed items to the Duke GME Office or your Duke Program Coordinator.
Durham VA Medical Center [insert mail code from Point of Contact document]
Attn: [insert name of DVAHCS point of contact from the Point of Contact document]
508 Fulton Street
Durham, North Carolina 27705
Due Date - April 12, 2019
Welcome Letter (For your records)
Appointment Letter (Review, sign bottom and return this document to DVAHCS Service POC)
VA Form 10-2850D, Application for Health Professions Trainee, Dated Nov 2011
(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”.
(Please provide your complete name & SSN at top of Pages 2-4. Sign pages 3 & 4. Return this document to DVAHCS Service POC.)
Form (OF) 306, Declaration for Federal Employment, Revised October 2011
(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 Service POC)
Determination & Certification of English Language Proficiency (Fill in your information. Return this document to DVAHCS Service POC.)
Random Drug Testing Notification and Acknowledgement (Fill in your information and return this document to DVAHCS Service POC)
DO NOT SIGN: Until you are instructed to sign while in the presence of a VA Official
Fingerprint Prep Sheet (Complete all boxes and return to DVAHCS POC)
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: __________________
DVAHCS POC email: ________________
DVAHCS POC telephone #: ______
Provide your POC a copy of your course completion certificate.
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. Locations for courtesy fingerprints can be found at: http://www.va.gov/pivproject/piv_badge_offices.asp. Advise POC when courtesy prints were taken.
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 DVAHCS service POC. Include copy of VISA)
Personal Identity Verification (PIV) (Submit a copy of your social security card and driver's license, state ID or VISA prior to orientation.)
Please notify POC of any changes to Driver’s License, State ID or VISA prior to orientation.
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 to DVAHCS Service POC.)
Current PIV badge holders (If you have a PIV badge from another VA facility, please advise your POC.)
NPI Number (Print Page with NPI Number. Send page to your DVAHCS POC)
Identification (Bring two ID’s from the List of Acceptable Forms of ID to your DVAMC orientation/appointment. Duke ID will not suffice.)
Standard Form 61, Appointment Affidavits, Revised August 2002
DO NOT SIGN: Until you are instructed to sign while in the presence of a VA Official. Return this document to DVAHCS POC.