United States Department of Veterans Affairs

Central Alabama Veterans Health Care System (CAVHCS)

Nursing Training Program - Application Information

All students (and instructors) wanting to perform a clinical training assignment at the Central Alabama Veterans Health Care System (CAVHCS) must complete the items listed below.  Once ALL items are complete, the entire packet of original printed items must be returned to the Education Service Line at least four weeks before the scheduled clinical training date.

All Nurse Instructors:  If you will be at CAVHCS with your students you must go through a credentialing verification process if not previously accomplished.  You must also complete this checklist if not previously submitted. Contact Patricia Randall at 334-727-0550, ext. 3246.


Getting Started:

 

Make sure you have a printer available, as some of these forms cannot be saved.

Follow all instructions carefully. Select and complete per the "Special Instructions" and any other instructions on the form or training resource. Return all forms as one packet in the same order as outlined below..This will ensure your paperwork is processed in a timely manner.

  1. This is NOT optional, complete sections A, H and I. Complete and print pages 3 and 4 only), OF-612.
  2. Complete, print and sign the Declaration of Federal Employment, form OF-306.
  3. Complete and print VA Clinical Trainee Registration Form - VA Form 10-0410.
  4. Complete, print and sign the Nursing Scope of Practice form.
  5. Complete section 1, print, and sign the Request for Personal Identity Verification Card, VA Form 0711. NOTE: The day you come for finger printing and ID badge you must present two forms of identification as listed on page 5 of this form.
  6. Complete the VHA mandatory trainings for trainees. Directions for logging in and locating requirements are included in the attachment (see attached Signing up for the VA Employee Education System). Be sure to read/print this first. Log into the following website and complete the mandatory training course (annual requirements) and print the certificate.
    https://www.ees-learning.net/
  7. Please read, print, then initial and date each page and then sign and date the last page of the National Rules of Behavior (Attached VA Handbook 6500).
  8. Print the attached Student Health Requirements form and have the appropriate school official and/or student complete and return with package.
  9. Complete, print and sign Special Agreement Form (SAC).

Send completed processing packet to the following address:

Central Alabama Veterans Health Care System                  

Attn: Lynette Stapleton (11E)

215 Perry Hill Rd

Montgomery, Alabama 36083

 

For assistance contact Lynette Stapleton

Lynette.Stapleton@va.gov or 334-272-4670, ext. 4922


NOTE: Incomplete student processing packets will not be processed and you will not be able to start your clinical training on time.

Upon receipt of your forms, our Human Resources department will contact you to arrange a time for you to come to the facility for fingerprinting and other entry processing requirements. A complete background check including fingerprinting is required for all VA staff and trainees. The following documents are required at time of fingerprinting:

  • One government issued photo ID (i.e. driver license, military ID, passport) and one non-photo ID (see list on VA Form 0711, page 5, item 4 above).
  • Permanent Resident Card (if applicable).
  • Vehicle Registration and proof of insurance (if applying for a VA parking permit).