<p> Southern AZ VA Health Care System (SAVAHCS) Background Requirements</p><p>Welcome to SAVAHCS. It is the responsibility of the Personnel Security & Suitability Office to determine suitability for every fellow/resident coming to work at the SAVAHCS by completing fingerprints and the Office of Personnel Management background investigation.</p><p>You can be fingerprinted at the nearest VA facility with fingerprinting capabilities, prior to arriving in Tucson. If you decide on courtesy fingerprints, complete the Courtesy Fingerprint Worksheet and Courtesy Fingerprint Letter. Contact one of the listed VA facilities with fingerprinting capabilities to schedule a fingerprint appointment. Take these forms with you and bring two forms of government issued photo identification. </p><p>If you have any questions or need any further assistance with the background requirements, please contact an individual below:</p><p>John A. Beets III Jesse Nino Personnel Security Specialist Security Assistant (520) 792-1450 x4361 (520) 792-1450 x4177 [email protected] [email protected]</p><p>Mailing address: Southern AZ VA Health Care System Personnel Security & Suitability Office (9-05) 3601 S. 6th Avenue Tucson, AZ 85723 DEPARTMENT OF VETERANS AFFAIRS Southern Arizona VA Health Care System Tucson, AZ 85723</p><p>COURTESY FINGERPRINT LETTER</p><p>January 3, 2013</p><p>To Whom it May Concern</p><p>______is identified as a Resident physician / Fellow with a scheduled rotation at the Tucson VAMC (Southern Arizona VA Healthcare System). Please perform a courtesy fingerprint.</p><p>SOI: VAE9 SON: 1438</p><p>If you have any questions regarding this matter, please contact our Human Resources Office at (520) 792-1450, John A. Beets III, (ext 4351, [email protected]) or Jesse Nino (ext. 4177, [email protected]).</p><p>Mailing address: Southern Arizona VA Health Care System Personnel Security & Suitability Office (9-05) 3601. S. Sixth Avenue Tucson, AZ 85723</p><p>Sincerely yours,</p><p>Q Scott Ringenberg, M.D. Designated Learning Officer Southern Arizona VA Healthcare System Clinical Associate Professor of Medicine Department of Medicine University of Arizona College of Medicine Courtesy Fingerprint Worksheet Name: FULL LEGAL NAME (LAST) (FIRST) (FULL MIDDLE/IO/NMN) Other Names Used </p><p>Other Names Used Male SSN: Date of Birth: MM/DD/YYYY Female Chinese Indian Japanese Indonesian (A) Filipino Asian Indian Korean Samoan Polynesian any other Pacific Islander (B) Black Race: (Check One) American Indian Eskimo (I) Alaskan Native Native Person w/Tribal Affiliation (U) Undeterminable Race Caucasian Mexican (W) Central or South American other Spanish Culture or Origin Cuban Puerto Rican BLK Black HAZ Hazel BLU Blue MAR Maroon Eye Color: (Check One) BRO Brown MUL Multicolored GRN Green PNK Pink GRY Gray XXX Unknown BAL Bald GRY Gray or Partially Gray BLK Black RED Red or Auburn BLN Blond or Strawberry SDY Sandy Hair Color: (Check One) BRO Brown WHI White XXX Unknown</p><p>Height: Weight: Place of Birth: City: State/Country (if not US): If foreign born, Citizenship: E-mail address: </p><p>Current address: Street Apt # (If applicable) City/State Zip code Employee Resident/Intern/Fellow Student Type of Fee Basis Temporary Employee Vet Canteen Svc Employee: Volunteer Contractor Without Compensation SON: 1438 SOI: VAE9</p><p>Southern Arizona VA Health Care System, 306 South 6th Avenue, Tucson, Arizona 85723 (520)792-1450/4361/4177</p>