Durham VA Health Care System
UNC Dental Residents
Congratulations on your new appointment as a dental 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 UNC Dental 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 you Durham VA Health Care System (DVAHCS) Point of Contact. Due Date April 12, 2019. Please send the completed documents to your Durham VA Coordinator. Do not send documents to UNC official or UNC Program Coordinator.
Please check the VA Program Coordinator List. Some trainees do not rotate at the DVAHCS and may not need to complete the paperwork.
VA Program Coordinators List
Durham VA Medical Center (insert mail code for Point of Contact document)
Attn: (insert name of DVAHCS Point of Contact from the POC document)
508 Fulton Street
Durham, N.C. 27705
Welcome Letter - For your records
Appointment Letter - Review, sign bottom and return to DVAHCS Service POC
VA Form 10-285d Application for Health Professions Trainee
Provide First, Middle and Last Name. If you do not have a middle name, please indicate with "NO MIDDLE NAME". If you only have initials in your middle name, please provide the initials and indicate "INITIALS ONLY". Please provide your complete name and SSN at the top of pages 2 & 4. Sign pages 3 & 4. Turn into DVAHCS Service POC.
Form (OF 306) Declaration for Federal Employment
Provide First, Middle and Last Name. If you do not hae a middle name, please indicate with "NO MIDDLE NAME". If you only have initials in you middle name, please provide the initials and indicate "INITIALS ONLY". Sign page 3 and turn into the DVAHCS Service POC.
Determination & Certification of Elnglish Language Proficiency
Fill in your information and turn into DVAHCS
Standard Form (SF-61) Appointment Affidavits
Do not sign until instructed to sign in the presence of a VA official. Fill in your information and return to DVAHCS POC.
VHA Mandatory Training for Trainees
Must be completed prior to submitting paperwork on April 12, 2019
Random Drug Testing Notification and Acknowledgement
Review, sign at the bottom and return to DVAHCS Service POC.
Finger Print Prep Sheet
Complete and return to DVAHCS Service POC
Courtesy Finger Printing If you have a nearby VA, you can begin the finger print clearance process prior to arriving in Durham. Present the DVAHCS Appointment Letter and the Courtesy Finger Prints 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-U.S. Citizen Request Memo
Only to be completed by non-US Citizen. Fill in highlighted blocks through item 3 and turn into DVAHCS POC. Include a copy of your VISA.
Personal Identity Verification
Submit a copy of your social security card, driver's license, state ID or passport to DVAHCS POC. Please notify the DVAHCS POC of any changes to identification prior to orientation.
Print Page with NPI Number. Send the page to your DVAHCS POC.
Bring two forms of ID from the list of acceptable forms of ID. UNC ID cannot be substituted for an acceptable form of ID.
Points of Contact:
Alicia Tsai, Dental Program Coordinator, 919-286-0411 x175070, email: email@example.com
Jonathon King, Academic Affiliation Coordinator, 919-286-0411 x175252, email firstname.lastname@example.org