Residents Onboarding Packets 2016 - Emory School of Medicine
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Transcript of Residents Onboarding Packets 2016 - Emory School of Medicine
SPECIAL AGREEMENT CHECK (SAC)
OFI Form 86C U.S Office of Personnel ManagementJuly 2005 Center for Federal Investigation Services
Agreement Number: OPM Use Only: OPM Codes: Case Number:
Agency use oniy (complete items 1 through 14 using instructions from the back)1. Subject’s Full Name 2. Date of BirthLast Name First Name Middle Name (at birth) Month Day Year
3. Place of Birth 4. SSNCity County State Country
5. Other Names Used and Dates When Used - —_____
Name From From Name From FromMonth Year Month Year Month Year Month Year
Name From From Name From FromMonth Year Month Year Month Year Month Year
6. Sex (1Iark one box) 7. Special Agreement Code 8. Position Title
LI Female
LI Male
9. SON 10. SOI 11. OPAC-ALCNuinber 12. Accounting Data
1 0 0 3 V A 6 0 3600-1200 101-50813. Name and Title of Signature of Requesting Official Telephone Number Date
Requesting Official404-321-6111 X6306
VAMC FINGERPRINTING INSTRUCTIONS
Fingerprinting is a critical security prerequisite for working at a VA facility and should be completed as soon as
possible. Please read these instructions carefully:
For trainees who live near the Atlanta VAMC or plan to be in the area before reporting in June:
1. Complete the form Electronic Fingerprint Submission Form and submit it with all your other application
documents
2. Contact the Atlanta VAMC fingerprinting office to schedule a fingerprinting appointment:
Fingerprinting Office Phone Number: (555) 555-5555
Standard Fingerprinting Hours of Operation: M-F 8:00-5:00
3. Bring two acceptable and original forms of identification to your scheduled fingerprinting appointment along
with a copy of your Electronic Fingerprint Submission Form.
For information about “acceptable” forms of identification, please visit the following web address:
http://vaww.va.gov/PIVPROJECT/Training_Docs/Identity_Documentation_Criteria.pdf
For trainees who DO NOT live near the Atlanta VAMC or plan to be in the area before reporting in June:
1. Complete the form Electronic Fingerprint Submission Form and submit it with all your other application
documents
2. Contact your nearest VA Medical Center and request an appointment to complete your fingerprinting
For a list of VA locations and Fingerprinting/Badge Office contact numbers, please visit the following
web-address:
http://vaww.va.gov/PIVPROJECT/PIV_Badge_Offices.asp
(Note: Different VA facilities complete fingerprinting in different areas. Please ask to be directed to the
fingerprinting location at the VA you contact if the number on the website does not lead you directly to
this location).
3. Complete section “A” of the form titled Government and Affiliates/Non-Contractors Special Agreement Check
(SAC) Fingerprint Request Worksheet. (Section “B” should be pre-populated*).
4. Bring the following to your fingerprinting appointment:
Two acceptable and original forms of identification. For Information about “acceptable” forms of
identification, please visit the following web address:
http://vaww.va.gov/PIVPROJECT/Training_Docs/Identity_Documentation_Criteria.pdf
The form titled Government and Affiliates/Non-Contractors Special Agreement Check (SAC) Fingerprint
Request Worksheet.
For trainees who are unable to obtain fingerprints prior to your program reporting date:
Please complete and submit your application packet including the form titled Electronic Fingerprint Submission Form.
Opportunities for fingerprinting will available after you report in to your training program in June but may detract from
your orientation or lead to delays in starting your VA clinical rotations.
For trainees without a Social Security Number:
Please contact the Education Office in Atlanta at: (404) 728-7703
Electronic Fingerprint Submission Form
Last Name
First Name
Middle Name
Social Security #
Date of Birth
Sex Male Female
Race
Height
Weight
Eye Color
Hair Color
Place of Birth (City & State)
Home Address
Citizenship
Employer
Scars, Marks, Tattoos
If you were fingerprinted or have an appointment to be fingerprinted at a VAMC location other than Atlanta, enter the facility name and contact number here.
Government and Affiliates/Non-Contractors
Special Agreement Check (SAC)
Fingerprint Request Worksheet
Part A – Individual’s Data (completed by the Individual being fingerprinted)
Employee (Full Name): _________________________________________________________________
Employee Social Security No.: ___________________________________________________________
Part B – Requesting Office Data (completed by the Requesting office)
Facility: Atlanta VAMC
Address: 1670 Clairmont Road, Decatur, GA 30033
Contact Name: Dr. John Doe Contact Phone: (404) 555-5555
Contact Email: [email protected] Contact Fax: (404) 555-5555
Submitting Office No. (SON): Security Office Identifier (SOI):
Part C – Submitting Office Data (completed by the Submitting Office)
Facility: _______________________ _____________________________________________________
Address: _________________________________________ ___________________________________
Contact Name: _______________________________Contact Phone: ___________________
Contact Email: ____________________________Contact Fax: ________________
Part D – Transmission/Release Method (check one) (completed by Submitting Office)
_____ FTS electronic submission using Requesting Office SON/SOI or Submitting Office’s SON/SOI
_____ SF-87 printed and mailed to OPM-FIS
_____ SF-87 printed and released to Individual
Part E – Purpose of the Request (check one) (completed by Requesting Office)
_____ Federal Applicant/Volunteer/Health Professional Trainee/etc. Screening
_____ OPM Investigation Requirement
_____ PIV/Non-PIV Card Requirement
*** Submitting Office will return this form to the requesting office contact identified in Part B above. Form will be
returned by secure means to safeguard Personally Identifiable Information (PII). Submitting Office should retain a
copy for their records.
_______________________________________________________ ________________
VA Security Specialist Date/Time
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Talent Management System
User Job Aid: Create New non-VA User Record Purpose
The purpose of this job aid is to guide users through the step-by-step process of creating the Create New User tool in the VA TMS. In this job aid you will learn how to:
A. Create New User Record 9 Steps
B. Complete Required Training 6 Steps
Task A. Go to www.tms.va.gov to Create New User Record
Step 1 From the Login page, in the brown navigation bar click the Create New User link.
Step 2
In the VA TMS Self Enrollment page, select the appropriate employment type. Step 3 Click Next.
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Talent Management System
Step 4 In My Account Information section, fill in all required fields as noted by the red asterisk, taking care to type accurately when entering your Social Security Number, e-mail address, and legal name; proceed to Step 5. Step 4a If you are a foreign national, click the click here link. Step 4b If there is a security pop-up click Allow. Step 4c In the email pop-up add any additional information to assist the Admin like your name and contact information and click Send.
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Step 5 In My Job Information section, fill in all required fields as noted by the red asterisk, entering the data provided by your VA point of contact where appropriate. VA City: Decatur VA State: GA VA Location Code: ATG VA POC: Choose from list attached Email: Choose from list attached Phone 4047287703
Step 6 If you are required to take training on the Health Insurance Portability and Accountability Act (HIPPA), click the box.
Step 7 Click Submit.
Step 8 From the congratulations page, note your VA TMS USER ID for future use.
Step 9 Click Continue.
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Task B. Complete Required Training
Step 1 From the Home page, hover over item in your To Do List to display the pop-up menu. Step 2 Click Go to Content. Step 3 Complete training per instructions.
Step 4 On the Online Content Structure page, click the Completed Work link.
Step 5 From the Completed Work page, hover over the title of the completed training to display the pop-up menu. Step 6 Click Print Certificate.
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Talent Management System
Program Coordinator/Director Name Specialty/Subspecialty E-Mail Address
Walid Nassif, MD, Psychiatry Addiction psychiatry [email protected]
David Fishman, MD, Chief, Anesthesiology Anesthesiology [email protected]
Maziar Zafari, MD, CCU Director, Cardiology Cardiovascular disease [email protected]
Benjamin Hunter, DDS, Chief, Dental Dentistry - Oral and Maxillofacial Surgery [email protected] Robert Swerlick, MD, Program Director,
Dermatology Dermatology [email protected]
Peter Thule, MD, Program Director Endocrinology, diabetes, and metabolism [email protected]
Kimberly House, MD, Chief, NHCU Family medicine [email protected]
Shanti Srinivasan, MD, Chief, Gastroenterology Gastroenterology [email protected]
Anna Mirk, MD, Geriatric Fellowship Geriatric medicine [email protected]
Walid Nassif, MD, Psychiatry Geriatric psychiatry [email protected]
Maria Ribeiro, MD, Chief, Hematology/Oncology Hematology and Oncology [email protected]
Tammie Quest, MD, Chief of Hospice and Palliative Care Hospice and Palliative Care [email protected]
Abeer Moanna, MD, Chief, Infectious Diseases Infectious Disease [email protected]
Shahed Brown, MD, Associate Program Director Internal medicine [email protected]
James White, MD, VA Coordinator- Fort MacPherson CBOC Internal medicine [email protected]
Kreton Mavromatis, M.D., AVAMC Chief of Interventional Cardiology Interventional cardiology [email protected]
Lynn Schlanger, MD, Chief, Nephrology Nephrology [email protected]
William Tyor, MD, Chief, Neurology Neurology [email protected]
Scott Bartley, MD, Chief, Nuclear Medicine Nuclear medicine [email protected]
Jennifer Goedken, MD, Chief, Gynecology Obstetrics and gynecology [email protected]
D'Nyce Williams, MD, Women's Health COE Director Obstetrics and gynecology d'[email protected]
Steven Urken, MD, Chief, Ophthalmology Ophthalmology [email protected]
John Louis-Ugbo, MD, Interim Chief, Orthopaedics Orthopaedic surgery [email protected]
Carrie Flanagan, MD, Chief, Otolarynology Otolaryngology [email protected]
Craig Campus, MD, Acting Chief, Laboratory & Pathology Pathology-Anatomic and Clinical [email protected]
Laura Lee, MD, MBA, Chief, PM&R Physical medicine and rehabilitation [email protected]
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Talent Management System
Mark Walsh, MD, Interim Chief, Plastic Surgery Plastic surgery [email protected]
Angel Jimenez, DPM, Program Director Podiatry Surgery [email protected]
Yvette Williams, MD, MPH, VISN 7 Physician Preventive medicine [email protected]
Walid Nassif, MD, Psychiatry Psychiatry [email protected]
Walid Nassif, MD, Psychiatry Psychosomatic Medicine [email protected]
Ruxana Sadikot, MD, Associate Program Director, Pulmonary/CCM Fellowship
Pulmonary disease and critical care medicine [email protected]
Bruce Hershatter, MD, Chief, Radiation Oncology Radiation oncology [email protected]
Ronald Mixon, MD, Assistant Chief, Radiology Radiology-diagnostic [email protected]
Karen Atkinson, MD, Chief, Rheumatology Rheumatology [email protected]
Octavian Ioachimescu, MD, Sleep Medicine Physician Sleep Medicine [email protected]
Jackson Slappy, MD, Staff Physician, Surgery Surgery-general [email protected]
Felix Fernandez, MD, Staff Physician, Thoracic Surgery Thoracic surgery [email protected]
Stephanie Brown-Johnson, MD, Primary Care Physician Transitional year [email protected]
Muta Issa, MD, Chief, Urology Urology [email protected]
Ronald Mixon, M.D. Interventional Radiology Vascular and interventional radiology [email protected]
Atef Salam, MD, Chief, Vascular Surgery Vascular surgery [email protected]
