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Durham VA Health Care System

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Greenville HCC Stipend Residents

Congratulations on your new appointment as a trainee at the Greenville Health Care Clinic (GHCC). We are excited to have you on the team as part of the Durham VA Health Care System. We hope your time with us is both exciting and motivating. Below you will find links to the GHCC Paperwork required for Associated Health Trainees
Complete, print out, sign and turn in all paperwork together and send to Barbara Winslow at Greenville VA HCC (GHCC). Again, congratulations and welcome to the team. 

Mailing Address:

Greenville HCC
401 Moye Blvd
Attn: Barbara Winslow
Greenville, NC 27834

Am I Eligible - Download and complete this checklist to be sure you meet all eligibility requirements to train at VA facilities. 

VA Form 10-0453 HR Screening Checklist Dated January 2017,

(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”.  (Provide your SSN) (Your Service/Office is: Education) (Your Service/Office is: Greenville HCC) (Type of Appointment is: Healthcare Professions Trainee) 

Welcome Letter (For your records)   

VA Form 10-294 Letter for ECU GME Appointment. Complete highlighted sections, print out, sign and turn in all paperwork together. Send to Barbara Winslow at Greenville VA HCC. Include a copy of Visa and passport if non-US Citizen.

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. (Complete, print out, sign pages 3 & 4 and turn in all paperwork together. Send to Barbara Winslow at Greenville VA HCC)

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”.  (Complete, print out, sign page 3 and turn in all paperwork together. Send to Barbara Winslow at Greenville VA HCC)

Selective Service System: Male trainees are required to visit https://www.sss.gov to register, 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. (Send a copy of this letter along with all of your paperwork to Barbara Winslow at Greenville VA HCC) 

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 gov 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 (Complete, print out, sign and turn in all paperwork together. Send to Barbara Winslow at Greenville VA HCC)

Random Drug Testing Notification and Acknowledgement (Complete, print out, sign and turn in all paperwork together. Send to Barbara Winslow at Greenville VA HCC) 

Fingerprint Prep Sheet (Complete, print out, sign and turn in all paperwork together. Send to Barbara Winslow at Greenville VA HCC)  

Courtesy FingerprintingIf you have a nearby VA, you can begin the fingerprint clearance process prior to arriving in Greenville, NC (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.aspAdvise Barbara Winslow at Greenville VA HCC when courtesy prints were taken.  

VHA Mandatory Training for Trainees (MTT):  Go to TMS website-Self register and complete MTT. Provide Barbara Winslow, at the Greenville VA HCC, a copy of your course completion certificate.

You need the following information to complete self-registration:

VA Location: DUR POC: Dalonia Clemons, Program Support Assistant 

POC phone number: 252-830-2149 ext. 143323

POC Email: Dalonia.Clemons@va.gov

*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.

NON-US Citizen Request Memo (If applicable) (Only to be completed by non-US Citizens.  Complete highlighted blocks through item 3, print, sign, and turn in with all paperwork.   Send to Barbara Winslow at the Greenville VA HCC. Include a copy of VISA and passport) 

Personal Identity Verification (Submit a copy of your social security card and driver's license, state ID or VISA with all other paperwork. Send to Barbara Winslow at the Greenville VA HCC. 

Please notify Barbara Winslow 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, print, sign, and turn in with all paperwork. Send to Barbara Winslow at the Greenville VA HCC.  

Current PIV badge holders (If you have a PIV badge from another VA facility, please advise Barbara Winslow) NPI Number (Print Page with NPI Number. Send to Barbara Winslow at the Greenville VA HCC) I

Identification
 (Bring two original/current ID’s from the List of Acceptable Forms of ID. School ID will not suffice.) 

Standard Form 61 Appointment Affidavits, Revised August 2002 Complete first six boxes only.   Position to which appointed: your current title as trainee. Date appointed. Date you start your rotation at the Greenville HCC. Department or Agency: Veterans Affairs. Place of Employment: GHCC 558GA. Print out and do not sign. You will sign of the first day of rotation with a VA official present (Leave the signature of appointment line blank). Turn in with all paperwork. Send to Barbara Winslow at the Greenville VA HCC.  

VISN 6 Standardized Computer Access Request Form

Complete form: select new user if no previous VA history; select re-activation if you have previously been at VA; Access to: Durham; Appointment status: select correct box; Type of Access Needed: check all boxes; Certifications: check mandatory training for trainee’s box; and Requested menus and security keys- leave blank. Turn in with all paperwork. Send to Barbara Winslow at the Greenville VA HCC.  

CPRS Tab by Tab Training Electronic Click on “Go to course content”. You must complete all 27 sections of the video training. At the bottom right corner, click on “next section” to complete all 27 sections. Once all sections have been completed, the certificate printing will be available.   At the end of section 27, click “Next Section” and follow the instructions for printing a certificate.   Turn in with all paperwork.   Send to Barbara Winslow at the Greenville VA HCC.