The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

LAHEFSA Research and Research Support Screening Form 2023-2024

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LSUHSC-NO affirms its commitment to equal employment opportunity in the recruitment, hiring, transfer, promotion, and other terms or conditions of employment without regard to race, color, ethnicity, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age (over 40), spirituality, socio-economic status, disability, genetic information, family status, protected veteran's status, experiences, opinions or any aspect of one's social identity or other non-merit factor which cannot lawfully be used as the basis for an employment decision

All research and research support final applicants will be screened according to Louisiana R.S. 17:1826.3., the Louisiana Higher Education Foreign Security Act (LAHEFSA).

Please complete the survey below, and upload all required documents. Please ensure you are prepared to submit all required information and documents.

Information collected will be retained for the current active period plus five calendar years according to the LSUHSC-New Orleans Record Retention Schedule under state law.

Please do not send any survey responses or inquiries regarding this survey to the hiring department or student affairs office, as they do not have access to your submission or the survey system.

Please direct all questions or concerns to: lahefsa@lsuhsc.edu.

The option "" can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?

First Name

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Last Name

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Email Address

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Department/School Applied To

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Department/Student Affairs Contact Name

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Department/Student Affairs Contact Email

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Are you a U.S. citizen?

* must provide value

Yes

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Are you a citizen of any country outside of the U.S.?

* must provide value

Yes

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Please check all countries where you are a citizen.

*Please note that the current federal administration does not recognize Taiwan as independent from the People's Republic of China under the "One-China" policy.

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People's Republic of China

Cuba

Iran

North Korea

Russia

Venezuela

None of the Above

Are you a U.S. Permanent Resident?

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Yes

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Please upload a copy of your Permanent Resident Card

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Do you have any professional affiliations with institutions, organizations, entities or individuals outside of the U.S.?

* must provide value

Yes

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Please check all countries where you have any affiliations or appointments.

*Please note that the current federal administration does not recognize Taiwan as independent from the People's Republic of China under the "One-China" policy.

* must provide value

People's Republic of China

Cuba

Iran

North Korea

Russia

Venezuela

None of the Above

Do you have any previous employment outside the U.S. at least one year in duration?*

* must provide value

Yes

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Please check all countries where you have been employed for at least one year.

*Please note that the current federal administration does not recognize Taiwan as independent from the People's Republic of China under the "One-China" policy.

* must provide value

People's Republic of China

Cuba

Iran

North Korea

Russia

Venezuela

None of the Above

Do you have any previous training outside the U.S. at least one year in duration?*

* must provide value

Yes

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Please check all countries where you received at least one year of training.

*Please note that the current federal administration does not recognize Taiwan as independent from the People's Republic of China under the "One-China" policy.

* must provide value

People's Republic of China

Cuba

Iran

North Korea

Russia

Venezuela

None of the Above

Upload copy of current passport(s) biodata page. Include all passports which you currently possess.

If you are a U.S. citizen and do not have a current passport, then you may upload your U.S. birth certificate or certificate of naturalization in lieu of the passport.

* must provide value

Upload file

Are you currently in the United States?

* must provide value

Yes*

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Upload copies of your current immigration/status documents.

* must provide value

Upload file

Upload documentation explaining your international (non-U.S.) travel history from the past 5 years.*

* must provide value

Upload file

Have you ever submitted a DS-160 (Online U.S. Non-immigrant visa application)?

* must provide value

Yes*

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Upload copy of most recent DS-160 * (Online U.S. Nonimmigrant Visa Application) submitted

Upload file

You may provide alternative documents in lieu of the most recent DS-160 (Online U.S. Nonimmigrant Visa Application) submitted if you do not have access to that document. You must replicate your previously submitted DS-160 to provide an alternative form.

The link provided here is a sample DS-160 that shows what questions are asked on that form (varies some depending on application type) so you can replicate what was previously submitted using this sample (starts on Page 7) and attach that to the notarized affidavit.

You must also provide a signed and notarized affidavit regarding your most recent DS-160 submission. A template affidavit is provided below for modification, completion and notarization.

Template Affidavit for submitting DS-160 alternative.docx

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Upload Complete Resume and CV

Must include the following:

Every Institution of higher education attended. Please provide the full name of the institution and geographical location (city, state, country) of the institution.
All previous employment since age 18
- For each position held, please provide a start and end date (month+year) ,full employer name, and geographical location (city, state, country) of the employer.
- Any applicant who has continuously been enrolled and/or employed in the United States for at least 20 years can limit their previous employment history to the past 20 years.
- Please acknowledge any gaps in your resume and provide explanations for these gaps.
  - We have to account for the full period from your 18^th birthday to the current date (full time student, unemployed, seeking employment, etc.).
    - If filling employment gaps with educational attendence, please include start and end dates (month+year) for each institution or program attended.
List of all published material to which you significantly contributed (even if not listed as author)
List of all current and pending research funding (including amount and source, brief research description, and role on project)
List of all Non-University professional activities including any affiliation with an institution or program outside the U.S. (examples-expert witness, general consulting, publishing agreements, self-employment or business operations, board positions, gratis faculty appointments)

* must provide value

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Does all of your employment history from your 18th birthday* appear on your uploaded CV or resume?

Yes

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Signature

By providing my signature , I certify that all information provided above, and included in document uploads, is complete and accurate. I understand that providing false or incomplete information is grounds for exclusion or termination from employment with LSUHSC New Orleans.

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Add signature

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.