Hines Veterans Administration Information

As Stritch students, you are very fortunate to have the Hines VA Hospital, whose grounds are adjacent to SSOM, available for part of your medical training. During the first two years, you may be going there to meet with preceptors or to shadow physicians, etc. During your clinical years at Stritch, most of you will have the opportunity to rotate at Hines at least once. While there, you will be caring for real heroes and be taught by dedicated faculty.

Because you will be working at a federal facility, the Office of Personnel Management requires everyone to complete some paperwork and to be fingerprinted. Your fingerprints are run through a variety of databases, including the FBI and the Terror Watchlist.  You may be fingerprinted at your local VA facility before you matriculate to Stritch.  If you do so, you will need to bring the SAC form (below) with you and you will need the following codes: SOI: VAA7, SON: 1255, OPAC: 3600 1200.  If you do not get fingerprinted at your local VA before arriving for orientation, please see the registrar on the first day of orientation to set up an appointment to be fingerprinted at Hines.  Medical Trainees are eligible for the non-PIV (Personal Identity Verification) badge, which is good for up to three years.  Prior to beginning your third year, you will need a PIV badge, which requires a very in-depth and comprehensive background investigation. The regulations change as they are reviewed on an on-going basis.

Please complete the forms listed below (also listed on the checklist) before orientation and submit them to the Office of Registration & Records (ORR) in room 220 when you participate in registration on the first day of orientation. 

Please note that one of the forms is the I-9 Employment Eligibility Verification, and the list of acceptable documents found on the last page of the I-9 are the same documents we require you to bring with you to registration on the first day of orientation.  These documents are: one document from List A which documents both your identity and your employment authorization (e.g. Passport or EAD) OR one document from List B to document your identity (such as a state-issued driver’s license) WITH one document from List C to document your employment authorization (such as your Social Security Card). If you have DACA status, please use your EAD as your document from List A.  When you go to Hines for fingerprinting, you will need to bring the same identity/citizenship documents with you. There will be information on fingerprinting available when you come through for registration during orientation.

Please see the Instructions for VA Paperwork and complete only those areas noted for each form and page.  If you are able to download the forms and complete them on your computer, please do so before printing them.  If not, print the forms and write legibly.  Sign only where directed and bring these forms with you to the first day of Orientation on Monday, July 24, 2017. Please do not email these forms to the admissions office.

Instructions for VA Paperwork – only fill in the areas noted

 Application for Health Professions Trainees

Page 1

1A Name, 1B if applicable.

2 Present Address.

3A Day and 3B Evening phone numbers (both must be filled out completely).

4 SSN.

5A e-mail address, 5B alternate e-mail address (if applicable).

6 Birth Date.

7A Hines, IL, 7B Start Date  07/2017, 7C End Date 05/2021.

8A in US military?, 8B Reserves or National Guard?, 8C Branch of Service.

9A Citizenship, 9B Country of Citizenship.

10A-D complete only if you are NOT a US citizen – DACA use 10C – EAD for visa type and EAD number for visa number with issue and expiration dates.


Page 2
Fill in name and SSN at top of page and complete Section VII-Education and Training.

Page 3
Fill in name and SSN at top of page, answer 21, 22, 23, and complete  XI, if needed, and sign and date in 24A and 24B.

Page 4
Fill in name and SSN at top of page, check all boxes in authorization area, sign and date.

 Declaration for Federal Employment

Page 1
Items #1, 2, 3, 4, 5, 6 (both day and night must be completed), 7 (a, b and c if applicable), 8, 9, 10, 11, 12, 13

Page 2
Items #14, 15, 16, 17a sign and date.  You do NOT sign 17b until processing.

 I-9 Form

   Complete Section 1 Employee Information and Attestation and sign where indicated.  Please print the pages that contain Sections 1, 2, and 3 and bring them with you to Registration on the first day of Stritch Orientation. Review the List of Acceptable Documents.  You will need to present 1 document from List A or 1 document each from List B and List C with the I-9 form.

 SAC Form (you will need this for fingerprinting)

  At the top, check New Employee. For Job Title use “WOC – Medical Student.” Leave Service blank. Check WOC for Type of Appointment. Bring this form with you when getting fingerprinted.

Appointment Affidavit

 Position to which Appointed is “WOC – Medical Student.” Leave Date Appointed blank. Sign as Appointee under C.