House Officer (Residents & Clinical Fellows)

HOUSE OFFICER (RESIDENTS & CLINICAL FELLOWS) APPOINTMENT CHECKLIST

FORMS COMPLETED BY THE EMPLOYEE:

1 Biographical Data 2 Employment Eligibility - I 9: Please attach copies of photo ID and proof of U.S. citizenship or a Permanent Resident Card (see page 9). Originals will need to be viewed by Human Resources prior to orientation on June 19. Failure to submit originals will results in a delay in your start date. 3 Invitation for Self Identification 4 Voluntary Self – Identification of Disability 5 Online Benefit Training: Keep the copy labeled Employee Copy in order to complete the online information. This training must be completed prior to orientation on June 19. 6 ACA Benefits Information 7 Direct Deposit Form 8 Federal Tax W4 9 Louisiana State Tax L4 10 Pre - Existing Conditions E2 11 Confidentiality Agreement 12 Code of Conduct 13 Appointment Affidavit 14 Public Records Act 15 HIPAA Training Acknowledgment: Return page 1 only. 16 Recoupment Policy 17 Influenza Vaccine Policy

I acknowledge receipt and completion of the above listed information:

______Signature of Employee Date

______Signature of Human Resource Representative Date

*An official copy of your transcript from your terminal degree granting institution is required. Request one be sent to:

LSUHSC-Shreveport Human Resource Management Attn: Unclassified Staffing 1501 Kings Highway/P.O. Box 33932 Shreveport, LA 71130-3932

Rev. 3.2014