VA Los Angeles Ambulatory Care Clinic (Los Angeles, CA) VA-LOS ANGELES
- Current PPD or negative chest x-ray (within THREE months of start date). Per the ACOS Education Department, there is now a policy change regarding TB testing. All incoming residents/interns/post docs and trainees should have TB testing completed within THREE months of their rotation start date. Students will need to give Dr. Diana Wu a copy of their results on the first day of clinic.
- Hep B
- Physician’s Evaluation/Health History Review
- Proof of influenza vaccine for all students rotating during Fall 1, Fall 2, Spring 1 and Spring 2. Complete the HCP Flu Vaccination Form. Influenza must be completed by November 30th.
- Covid-19 Vaccine and booster card. Please send a pdf copy of your vaccine card to Dr. Diana Wu of VA Los Angeles Ambulatory Care Clinic at email@example.com. If you require a medical or religious exemption, please let her know and complete VA Form 10-263.
- If student is not receiving the COVID-19 vaccine, they must file for an exemption (medical or religious) using the VA Form 10-263 and submit it to Emerald Marquez-Aldanese at firstname.lastname@example.org.
Immunizations Records Submit to and Date:
- All immunizations should be up to date before rotation start date. Make sure that the Admissions and Students Affairs Office (ASAO) has your up to date immunization records. Do not submit any immunizations to VA Los Angeles, except the proof of flu vaccination when you answer “Yes” to the question regarding it one of the forms below.
- Covid-19 Vaccine and booster card. Please send a pdf copy of your vaccine card to Dr. Diana Wu of VA Los Angeles Ambulatory Care Clinic at email@example.com. If you require a medical or religious exemption, please let her know.
- All trainees assigned to the Los Angeles (Los Angeles Ambulatory Care Center) rotations must have all paperwork completed and shipped to Ms. Emerald Marquez-Aldanese between 60 to 80 days before the start of your rotation.
- The documents below must be completed before you will be allowed to rotate to any Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) site. Please be sure that everything is filled out completely prior to returning the packet to your training program coordinator for review and transmission to GLA. The federal government is very strict about these forms, therefore those that are not completed correctly will be returned. An original of each form must be submitted to the VA. Do not use double sided forms. If you print in INK, ensure that it is legible and readable. (If you made a mistake on the form and strike it, please initial the strike through). DO NOT STAPLE ANY OF THE DOCUMENTS TOGETHER. PLEASE SUBMIT ALL ORIGINAL FORMS IN ONE PACKET AND SEND IT VIA UPS OR FEDEX (most economical of these are okay). YOU CAN ALSO SEND VIA US MAIL (but VA Los Angeles is not responsible for any loss of mail or delay as the mail goes through their main mail room).
The fillable forms for items 1 through 6 are here: VA LA Application Packet. Forms for items 7 through 12 are linked below. Instructions for all forms are below:
- Application for Health Professions Trainees VA Form 10-2850D
- Complete the entire form. Make sure to include City, State and Zip code for all questions that ask for these information.
- Make sure to complete sections 16 and 17.
- Sign and date pages 3 and 4 (electronic signatures are not accepted). A VA official will sign off in Section IV.
- Make sure to include City, State, and Zip Code for all questions that ask for this information.
- Declaration for Federal Employment OF-306
- On item 1 (FULL NAME) provide full name (FIRST, FULL MIDDLE, LAST). If you don’t have a middle name, indicate “No Middle Name”.
- If you have only initials in your name, provide them and indicate “Initial only”.
- Answer (check off) all YES/NO questions.
- On the OF-306 form, in block 5, if no other names were ever used, please make sure to write in N/A and do not leave it blank.
- For Selective Service Portion:
- Females should check NO in 7a, NO in 7b, and enter “I am female” in section 16.
- Males will enter YES in 7a, YES (we hope) in 7b, and either YES or NO in 8. Selective Registration for males can be verified on line: https://www.sss.gov/Home/Verification
- If you answered “No” to item 7B, indicate the reason on page 3, item 16.
- Please print the registration letter and attach to the Statement of Selective Service.
- If you answer YES to questions 9-13, you must provide the date, explanation of violation, place of occurrence, and the name and address of the police department/court involved
- Student should also sign and date on line 17a ONLY, not on 17b. DO NOT SIGN 17B.
- Fingerprint Request Form
- Check: Health Professions Trainee
- Under “FULL NAME”, provide Last, First, and Middle.
- “POSITION TITLE”, Optometry Student
- “SERVICE OR DEPT.”, write in the service you’re rotating through
- “POSITION”: Resident; Fellow; Medical Student; Dental Student; Associated Health Program, e.g., Pharmacy Student
- “VA WORK LOCATION”: GLA LAACC
- “POC”: Dr. Diana Wu
- “POC Phone Number”: (213) 253-2677 x 4624
- “HEALTH PROFESSIONS TRAINEES ONLY” School affiliate is UC Berkeley, TRAINING PROGRAM is Optometry. PROGRAM END DATE – put end date of your session.
- “RACE”: White, Black, Asian, Hispanic. Unfortunately, “Multi-racial” or “Other” are not available in the choices
- Information printed on this form must match EXACTLY to the 2 forms of ID that will be presented for security clearance. For example, if your IDs show your full middle name you must write it out (i.e. Delta, John Alpha, NOT Delta, John A.).
- If you are having your prints taken at another VA facility outside of GLA by courtesy, indicate the SON=1625 and SOI=VAP4 on the Fingerprint form so the prints will be correctly sent to GLA for adjudication.
- I-9 Form (Read instructions and complete Section 1)
- Random Drug Testing Notification and Acknowledgement Memorandum
- Appointment Letter for Trainees – Appointed Without Compensation (WOC)
- Statement of Selective Service Registration Status (Applies to male applicants only. Register by age 26. Female applicant trainees do not have to complete the “Selective Service Registration” form.) Unless male trainees meet certain exemptions under the Selective Service law, they must be registered with the Selective Service System. Otherwise, they are ineligible for appointment by executive agencies of the Federal Government. Check one, sign and date form. Verify your registration via: https://www.sss.gov/Registration-Info/Who-Registration. Please print the registration letter and attach to the Statement of Selective Service.
- Non-Citizen Appointment Letter will be issued by the institution (when applicable for those students who are non-US Citizens). Please prompt Dr. Yu to complete for you.
- Mandatory Training for Trainees (MTT) Certificate of Completion (see below on how to access training and print certificate)
- International Students and Social Security Numbers:
- Health professions trainees (HPTs) training at VA medical centers receive temporary Federal appointments and personal identity verification credentials. To be properly vetted and eligible to participate in training, non‑US citizen HPTs who are temporarily in the United States must have:
- A nonimmigrant F-1 or J-1 student classification; or, an I-20 (or DS-2019) certificate of eligibility; AND
- A US Social Security Number
- Unfortunately the use of a “pseudo-SSN” is prohibited in certain Federal systems. Your facility may have found work arounds, however use of a pseudo-SSN, or other 9-digit number, will not be permitted after May 1, 2018. Therefore, we are notifying the field in advance of this change in the onboarding process for non-US citizen trainees.
- Application for Health Professions Trainees VA Form 10-2850D
Computer Access at the Department of Veterans Affairs and Talent Management System Self-Enrollment Instructions
In order to obtain computer access at the Department of Veterans Affairs (VA) Greater Los Angeles (GLA), ALL trainees MUST complete the appropriate “Mandatory Training for Trainees (MTT)” course in the Training Management System (TMS). The Certificate certifying the completion of the MTT in TMS must be submitted to the Program Coordinator along with the Trainee Application Packet so that an NT account for computer access can be established. The Mandatory Training for Trainees course must be taken on an annual basis (every 365 days). Computer access will not be provided to trainees that do not complete and submit both documents.
Talent Management System (TMS)
TMS website: https://www.tms.va.gov/SecureAuth35/
Returning Trainees: MTT “Refresher” (course # 3192008)
New Trainees: MTT (course # 3185966)
- Go to the Talent Management System Website: https://www.tms.va.gov/SecureAuth35/
- Select “Check System” link to make sure your computer will work with TMS. If you receive an error message, please contact the TMS Help Desk for assistance at (855) 673-4357.
- Click on “Create New User” (located in red bar approximately in the middle of the page). If you are a foreign national/do not have a Social Security Number, please follow the instructions on TMS on how to have a TMS account established after you select the “Create New User” tab. If you are a continuing trainee and have forgotten your username and/or password, please contact your TMS Coordinator or the TMS Help Desk for assistance.
- Select: VETERANS HEALTH ADMINISTRATION (VHA)
- Select: HEALTH PROFESIONS TRAINEE (Please do not select “WOC”)
- Fill out “My Account Information” with YOUR Personal Information (Be sure you use a valid email address as this will be used to send information to you. Do not use a medical school email address).
- Fill out My Job Information as follows:
- VA CITY: Greater Los Angeles
- VA STATE: California
- VA LOCATION CODE: GLA
- TRAINEE TYPE: (Specialty) Student (e.g. Optometry Student)
- SPECIALTY/DISCIPLINE: Select your training specialty/discipline (e.g. Optometry)
- VA POINT OF CONTACT: Obtain this information from the VA Service/ Program/Specialty Coordinator based upon your specialty (as of 5-17-18)
- FIRST NAME: Diana
- LAST NAME: Wu (O.D.)
- EMAIL: firstname.lastname@example.org
- PHONE #: 213-253-2677, ext 24611
- Click the SUBMIT button when all required fields are completed. You should now see the Congratulations! Screen. Note your Username/Email Address. WAIT 20 MINUTES
- After 20 minutes, please return to https://www.tms.va.gov/SecureAuth35/
- On the TMS 2.0 Login Screen, enter your Username/Email Address and click the SUBMIT button. An email will be sent to your Username/Email address containing a one-time-passcode—enter it using your keyboard or the on-screen number pad and click the SUBMIT button.
- During this first time log in, you will be asked to select and answer two security questions. These will be used to reset your TMS password. Select questions, enter response, confirm response.
- Click the SAVE button. You have now completed your TMS User Profile.
- Once you are registered and have your TMS account established, you will be automatically routed to the appropriate MTT course. If you are a new user, you are instructed to complete the “Mandatory Training for Trainees” course. If you have previously completed the “Mandatory Training for Trainees” course, please complete the “Mandatory Training for Trainees-Refresher” course.
- After the completion of the appropriate MTT, please return to your learning history and printout a copy of the certificate verifying the completion of the training. ALL trainees must submit an appropriate certificate verifying its completion.
Trainees are required to process through the GLA Human Resources Department (Recruitment/Placement and Safety/Security) prior to the beginning of their first day at GLA in 3 separate appointments as follows:
Fingerprint appointment – Due to a Federal mandate, students must be fingerprinted prior to their arrival at VA Los Angeles. The fingerprint appointment will be scheduled by the applicant trainee once the Service or Program Coordinator gives the go ahead signal to do so. The applicant will go to: https://app.waitwhile.com/book/fingerprinting
Please select “Student Fingerprinting”:[[[ insert photo ]]]
Select Desired Date/Time for your appt (GLA does offer Saturday appts), however they’ve asked that you please call 310-478-3711 x48778 the Friday before to double check if a security staff member will be working on the Saturday you wish to have your appt):[[[ insert photo ]]]
Enter your First name, Last name and phone # at the bottom of the page:[[[ insert photo ]]]
The trainee must bring 2 forms of “matching” ID’s to their appointment’s. All names must match identically on his/her forms of identification or the security team will not honor the appointment and
you will have to reschedule the appointment.
The trainee must complete this completed form VSC Form #2 (along with a copy of the Fingerprint Request Form (Fingerprint Request Form) and bring it to the appointment, if having prints taken another VA facility, other than West LA VA Medical Center. Here are instructions on how to complete the form:
- For the Facility Information:
VAMC Name & Location: LOS ANGELES ACC MSCBOC
PIV Office Official: Dwight John
Date Fingerprinted : (your scheduled appointment date)
The trainee must notify the Service PIV Sponsor of the scheduled appointment as they must
send in a clearance request out of state on your behalf.
If you are out of state, or having prints taken at another VA facility that is not WLA-VA, you will need make an appointment at another VA facility:
However, please be mindful, you must keep your coordinator at the West LA VA updated with your appointment details. You will be required to submit VSC Form #2 at this appointment, and your Fingerprint Prep Sheet. You will need the following codes on your forms, so that the fingerprints are sent to the VA in West Los Angeles, and not another VA facility. Failure to do so, will result in significant delays within your security clearance.
VA (GLA) – SOI: VAP4, SON: 1625
Please bear in mind that fingerprints are only good for 120 days so do not take fingerprints more than 120 days before the start of your rotation; the trainee must be badged within that time frame at West Los Angeles, otherwise, the fingerprint clearance will expire, and you must be fingerprinted again. The Service has to coordinate this process closely.
Badge Picture/Swearing In – Once the fingerprints clear, the Service PIV Sponsor will submit the request for the computer account and logical access of the resident/fellow. Once that is secured, the applicant will be advised to make a badge appointment thru https://V2.waitwhile.com/book/vhaglavapivoffi. Fifteen minutes before their appointment time, they have to go to HR Staffing (The Service PIV Sponsor can advise the name and location of the H/R specialist assigned to the Service) to be sworn in and appointed. Then the trainee proceeds to HR Security (Building 218, room 1) to take the badge picture and biometric information verified from the two state or government issued ID forms the trainee brings in (driver’s license and Passport) where your name is stated the same. If one ID has a middle name, and the other doesn’t, then that is not the same. Acceptable ID Matrix (PIV)
If you will be in the L.A. area, you may contact Dwight John to advise him of your appointment time for fingerprinting and issuance of your badge. His email is email@example.com. He will request your computer and logical access so he can initiate you in the badging portal and advise you to make your badging appointment. At that time, you will have to bring two state or government issued ID forms (driver’s license and Passport) where your name is stated the same on each form of ID. If one ID has a middle name, and the other doesn’t, your presented ID’s will not be accepted by the VA security office.
Badge Pick Up – The coordinator does not arrange this appointment for you. While attending your badging appointment, the security team will coordinate a day and time for you to pick up your badge. Please do not leave your appointment without clarifying a timeframe for your badge pickup. You may also call the security office at the West LA VA Medical Center at 310-478-3711 ext. 48778 to see if your badge is ready. ALL trainees must obtain a VA badge as per Department of Homeland Security requirements. The badge generally expires after 3 years, or at the end of the trainee’s rotation which would have been indicated by the Service PIV Sponsor on the PIV Badging Portal. It is the responsibility of the trainee to inform his/her PIV sponsor at least 6 weeks before it expires so it can be re-issued.
Please remember you will not be allowed to rotate and see any patient at any GLA site until the ENTIRE on-boarding processes are complete.
Dwight John is the main contact for all Optometry students, his email is Dwight.John@va.gov. Emerald Marquez-Aldanese handles your student documents. So you may want to make sure all were received, her email is emerald.marquez-aldanese@
If you have any questions regarding your paperwork, please email:
- Emerald Marquez-Aldanese, firstname.lastname@example.org, (310) 268-3155
- Anna Medina, email@example.com, (310) 478-3711 ext 46618
- Elizabeth T. Acosta, acosta2@va,gov, (310) 478-4711 ext 40809
- Dwight John, firstname.lastname@example.org, (310) 478-3711 ext 40263
Documentation Submit to and Date
- Due at least 60 days before the start of your rotation, forms should be sent to:
- ATTN: Emerald Marquez-Aldanese
- Program Specialist
- Office of the ACOS-Education
- Department of Veteran Affairs
- 11301 Wilshire Blvd, Building 218, Room 207-A
- Los Angeles, CA 90073
- Phone: (310) 268-3155
- Email: email@example.com
Each authorized absence will require a written case report (3 pages minimum) on a designated topic PLUS the appropriate make-up back at UCBSO. An e-mail containing number of days and reason for absence should be sent to Dr. Diana Wu at firstname.lastname@example.org and Dr. Chang Kim at email@example.com which will be forwarded to the Vice President of Clinical Affairs and the UCBSO Externship Director.