Central Alabama Veterans Health Care System (CAVHCS)

Optometry Externship Training Program- Application Information

All optometry externs 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 Optometry Service Line at least four weeks before the scheduled clinical training date.

Getting Started:

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

Follow all instructions carefully.

• Complete, print and sign the Optometric Extern Application.
• Complete, print and sign the Federal Employment Application form, OF-612.
• Complete, print and sign the Declaration of Federal Employment form, OF-306.
• Complete and print VA Clinical Trainee Registration Form - VA Form 10-0410.
• 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.
• Complete, print and sign the Optometry Scope of Practice form.
• 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/
• 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).
• Print the attached Student Health Requirement form and have the appropriate school official and/or student complete and return with package.
• Complete, print and sign Special Agreement Form (SAC).

Send completed processing packet to the following address:

Central Alabama Veterans Health Care System
Attn: Monsherri Golston (115S)
215 Perry Hill Road

Montgomery, AL 36109-3798

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

A complete background check including fingerprinting is required for all VA staff and trainees. Fingerprinting can be done at a VA near you and is highly recommended in order to expedite your background clearance. If you live in the near proximity to another VA please contact Ms. Golston at 334-272-4670, ext. 4096 and she can make arrangements for you to have your fingerprints completed at your local facility. If you have had your fingerprints checked by the VA within 120 days of your anticipated start date at CAVHCS, please provide Ms. Golston with the name of the VA where the fingerprints were checked.

If we are not able to have your fingerprints completed at least 2 weeks prior to your start date it may prolong your educational experience here at CAVHCS.

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).