INSTRUCTIONs FOR ALL PRE-LICENSURE STUDENTS (BSN/ADN/LPN/CNA/SURGICAL TECHs/ STERILE PROCESSING)

Welcome to the VA Boston Healthcare system. Please complete the following steps below prior to coming to credentialing STEP 1 (Your schools’ coordinator will give you the deadline, and collect document) *** Please type in the information, it should not be hand written***

1. PIV form 2. Health information

STEP 2 Fingerprinting Students must be fingerprinted 3-5 weeks prior to the face to face credentialing at the Brockton VA campus. This is to be completed at one of the campuses of the VA Boston Healthcare System Campuses which include:

Jamaica Plain

West Roxbury

Brockton Or other VAs Facilities for out of State students

Students are to provide Boston VA codes to the person doing the fingerprinting: SOI: VAJ0 SON: 1444 If students are not fingerprinted before the credentialing date, students will not be able to begin clinical with the rest of the group. Please call ahead of time to make an appointment at one of the offices listed below. Please bring picture ID to your appointment!

Brockton Human Resources PIV office 774-826-1721 774 826 1164

West Roxbury Human Resources PIV office 857-203-6064 857-203-6252

Jamaica Plain 857 364-5562 857 364-5561 STEP 3 Online Orientation Click on the following links (two on line orientations), (MUST BE COMPLETED BEFORE CREDNTIALING DATE, please bring Certificates/ tickets to orientation)

1. VA online orientation TMS, http://www.tms.va.gov/plateau/user/login.jsp (instructions are attached in the MCCP website under http://www.mass.edu/mcncps/Orientation/FsDocs.asp?msg=Information+updated )

2. Massachusetts Centralized Clinical Placement Online Orientation http://www.mass.edu/mcncps/orientation/welcome.asp (State of Massachusetts requirement)

STEP 4 Documents needed day of credentialing, please have paperwork filled out if any questions please leave blank and we will address credentialing day. Links to these documents are on the MCCP. PhD/NP/Grad students

• I-9 • VA-form 10-2850a (APPLICATION FOR NURSES AND NURSE ANESTHETISTS) • VA-from 4682-2 (CERTIFICATION OF LICENSURE, REGISTRATION, OR BAR MEMBERSHIP) • Optional Form 306 (DECLARATION OF FEDERAL EMPLOYMENT) • Statement of Commitment and Understanding for VA trainees • NEW EMPLOYEE ORIENTATION SUPPLEMENT for Clinical Trainees (only need last page signed) • (3) TMS certificates • Massachusetts Centralized Clinical Placement Ticket

BSN RNs/ADN RNs • I-9 • VA-form 10-2850a (APPLICATION FOR NURSES AND NURSE ANESTHETISTS) • Optional Form 306 (DECLARATION OF FEDERAL EMPLOYMENT) • Statement of Commitment and Understanding for VA trainees

• NEW EMPLOYEE ORIENTATION SUPPLEMENT for Clinical Trainees (only need last page signed) • (3) TMS certificates • Massachusetts Centralized Clinical Placement Ticket

LPNs/CNAs • I-9 • VA-form 10-2850c (APPLICATION FOR ASSOCIATED HEALTH OCCUPATION) • Optional Form 306 (DECLARATION OF FEDERAL EMPLOYMENT) • Statement of Commitment and Understanding for VA trainees • NEW EMPLOYEE ORIENTATION SUPPLEMENT for Clinical Trainees (only need last page signed) • (3) TMS certificates • Massachusetts Centralized Clinical Placement Ticket

Fingerprinting Parental consent for students under 18 (For High School CNA Students ONLY)

Surgical Techs./ Sterile Processing Students • I-9 • VA-form 10-2850d (APPLICATION FOR HEALTH PROFESSIONS TRAINEES) • Optional Form 306 (DECLARATION OF FEDERAL EMPLOYMENT) • Statement of Commitment and Understanding for VA trainees • NEW EMPLOYEE ORIENTATION SUPPLEMENT for Clinical Trainees (only need last page signed) • (3) TMS certificates • Massachusetts Centralized Clinical Placement Ticket