EMPLOYEE FORMS

All forms must be completed as part of the application process for VA paid employees/positions within Medical Research Service. Official job offers are made only by Human Resource Management staff.

 

• New Employee Information Sheet (to be completed by supervisor) 

• OF-306 Declaration for Federal Employment

• Scope of Practice

• VA Form 2850a - Application for Nurses and Nurse Anesthetists (if applicable)

• VA Form 2850c - Application for Associated Health Occupations (if applicable)

• A signed & dated copy of resume/CV

• A copy of college transcripts

Individuals paid by an institution other than the VA, who perform work at the VA and/or have access to VA Patient Information Systems must have a WOC Appointment. All forms must be completed prior to individual performing work at this facility. Paperwork must be received in the research office 4 weeks prior to requested start date.

 

ALL NEW WOCs:

STEP 1 - To initiate a WOC appointment, Supervisor to complete a New Employee Information Sheet and submit to the Management Assistant (216) 791-3800 x64660

STEP 2 - complete the following forms and send to the Management Assistant (216) 791-3800 x64660:

• Intellectual Property Agreement

• OF-306 Declaration for Federal Employment (as the WOC, you must sign and date line 17a only. DO NOT sign line 17b)

• Patient Data Sheet for TB Test

• Request For Personal Identity Verification (PIV) Card

• Scope of Practice

• SF61 Appointment Affidavit (notarization NOT required)

• VA Form 0710 - Authorization for Release of Information

• VA Form-10-230-covid-19-vaccination-form - please complete the form and submit along with a copy of your COVID vaccination card.

• A signed & dated copy of resume/CV

• ​FOR MDs, RNs, and LICENSED PROFESSIONALS:

  • VetPro Enrollment Form​

  • Credentialing Release of Information Authorization

  • Copy of SSN card (MDs only)

  • VA Form 2850a - Application for Nurses and Nurse Anesthetists (if applicable)

  • VA Form 2850c - Application for Associated Health Occupations (if applicable)

• FOR NON-US CITIZENS:

  • I-9 Employment Eligibility Verification

  • I-94 (found here https://i94.cbp.dhs.gov/I94/#/home)

  • Current/valid passport

  • Document that allows you to work in the US, such as DS2019 or I-20/F-1, or I797A or I797B Notice of Action/Approval Notice

STEP 3 - Create VAIRRS Account and upload CV/CITI training

• Please create an account in VAIRRS/IRBNet, if you have not already, to upload your CV/Resume and/or Citiprogram training.  VA Research now uses VAIRRS/IRBNet for tracking and storing pertinent Research Citiprogram training, CV/Resumes, Research Scope of Practice and study submission documents.

• Christina Raymond will upload your Scope of Practice in VAIRRS after she receives the completed copy signed by you and your PI and she has the ACOS of Research, Dr. Peachey sign it.

• For details on creating a VAIRRS account and uploading your training, see the New User Registration training energizer on our VAIRRS/IRBNet page.

​STEP 4 - Click here for training options (TMS/Citiprogram/Safety Training).

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ALL RENEWAL WOCs:

• OF-306 Declaration for Federal Employment (as the WOC, you must sign and date line 17a only. DO NOT sign line 17b)

• Self-Certification of Continuous Service

• SF61 Appointment Affidavit

• I-9, if applicable (see above FOR NON-US CITIZENS)

• A signed & dated copy of resume/CV

General Information

• IPAs are set up in 2-year increments for up to 4 years.

• IPAs always start on the 1st of the month.

• Employees participating in an IPA must be permanent employees of their institution for at least 90 days.

• IPAs are for 'higher level' positions, not for RA I's and/or Fellows.

• You are responsible for getting the signature of the participating institution.

• Paperwork must be received in the research office 4 weeks prior to requested start date.

 

STEP 1 - To initiate an IPA, Supervisor to complete a New Employee Information Sheet and submit to the Management Assistant (216) 791-3800 x64660

STEP 2 - complete the following forms and send to the Management Assistant (216) 791-3800 x64660

• IPA Assignment Agreement

• OF-306 Declaration for Federal Employment

• Request For Personal Identity Verification (PIV) Card

• VA Form-10-230-covid-19-vaccination-form - please complete the form and submit along with a copy of your COVID vaccination card.

• Scope of Practice

• A signed & dated copy of resume/CV

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Click here for training options.