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Complete, print out, sign and turn in all paperwork together and send to Delonia Clemons at Greenville VA HCC (GHCC). We are unable to accept partial onboarding paperwork. All paperwork will

be due during the resident’s orientation at ECU/Vidant. If you are not a part of this academic institution, your paperwork will be due 6 weeks prior to the start of your clinical

rotation.Again, congratulations and welcome to the team.  If you have any questions, regarding your paperwork, please feel free to contact: Megan Lewis, Program Support Assistant Email: 

[email protected]  Dr. Barbara Winslow, Director of Education Mailing Address: 401 Moye Blvd, Greenville, NC 27834 SCREENING CHECKLIST (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). SELECTIVE SERVICE INSTRUCTIONS 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 DALONIA CLEMONS 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. MANDATORY TRAINING FOR TRAINEES VHA

MANDATORY TRAINING FOR TRAINEES (MTT):  Go to TMS website-Self register and complete MTT. PROVIDE DALONIA CLEMONS, 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: Megan Lewis, Program Support Assistant   POC phone number:   POC Email: [email protected]  *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. PIV INSTRUCTIONS AND INFORMATION 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 Megan Lewis at the Greenville VA HCC. Please notify Dalonia Clemons of any changes to Driver’s

License, State ID or VISA prior to orientation. CURRENT PIV BADGE HOLDERS (If you have a PIV badge from another VA facility, please inform Megan Lewis).  NPI NUMBER LOOKUP NPI NUMBER (Print

Page with NPI Number. Send to Dalonia Clemons at the Greenville VA HCC)  COMPUTER ACCESS REQUEST FORM INSTRUCTIONS 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 Dalonia Clemons at the Greenville VA HCC.