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At least 6 weeks before your desired rotation start date, we must receive all of the forms indicated below.  All forms need to be reviewed for completion & verify that all information submitted is correct.

All forms can be found below. 

Use the Student WOC Application Checklist  to help keep you organized.

Of note, the Student Placement & Fingerprint Form must be received a minimum of 5 business days prior to coming in for fingerprinting.

DO NOT SIGN the Appointment Affidavits (Form SF-61 until you are instructed to sign while in the presence of a VA Official


The BLS/ACLS Certification Form form is to be signed by your Program Director

All of the above forms should be completed electronically & returned to VHACLAALLIEDHEALTHSTUDENTS@va.gov 6 weeks prior to the start of rotations:

For any question concerning any of the documentation requirements, please contact:

Candice Postle (contact information below)
Program Support Assistant
Research/ GME/ Staff Development

Louis A. Johnson VA Medical Center
One Medical Center Drive
Clarksburg, WV 26301

Candice Postle

Program Support Assistant, Research/GME/Staff Development

VA Clarksburg health care

Phone:

Email: Candice.Postle@va.gov

Fill out all required forms below:

Submit each document as a pdf, sign both areas (applicant and appointee) on the declaration of federal employment,  complete the blanks and sign as the appointee on the affidavit.

-Make sure each document is saved as a separate PDF before you send to the email group.

-On the Declaration of Federal Employment form, please sign both areas (applicant and appointee).

-Complete the blanks and sign as the appointee on the Affidavit.

Employment Eligibility Verification - USCIS Form I-9

 

At least four to six weeks before your desired rotation start date:

Please arrange to complete the fingerprinting process. It is during this span of time that you must schedule an appointment with the Personal Identity Verification (PIV) office located in Building 6 at the Clarksburg VA Medical Center (VAMC) campus. The number to reach HR is or ext. 3310 to get your fingerprints.

Directions from main building to PIV office:

  • Park in the main parking lot.
  • Enter the Medical Facility through the main entrance.
  • Take your first left after entering (towards the South Elevators).
  • Take the South Elevators to the Basement. 
  • Turn left off the elevators, and then left down the hallway. 
  • Turn right down a long hall just after passing a sliding glass door on your left. 
  • Continue down the hallway through an open door. 
  • Turn left at the end of the hall after passing through the open door and look for Room B232 on your right. 

On your first rotation day, you will need to bring in 2 forms of legal ID. Please review information as follows:

  • EFFECTIVE IMMEDIATELY, SCHOOL IDENTIFICATION CARDS ARE NO LONGER ACCEPTED as one of the two required types of identification for PIV credentials issuance.
  • Two identity source documents from the matrix below are required. Neither identity document may be expired or cancelled.
  • One ID must be from the Primary Identity Source Document column.
  • The second ID can be either a Primary Identity Source Document or a Secondary Identity Source Document.
  • Applicants may not provide two documents from the Secondary Identity Source Documents.
  • The two identity credentials must be different types of credentials. For example, a driver’s license from New York plus a driver’s license from Iowa is not an acceptable combination of identity documents.

List of Specific Identification Documents Required

Appointment Affidavit will be signed on the first day of your rotation