Tuesday, April 23, 2024
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Instructions:
Fill out the form below making sure to populate all required fields (marked with red asterisk).
Your password must include at least 6 characters including one upper case letter, one lower case letter, and one number.
You will be required to input your birthday/month and last four digits of your social security number for purposes of verifying LSU Health Shreveport employment history.
Upon successful registration, you will receive an email with a confirmation link. This link must be clicked before you will be allowed to log in to this site. We will not share your email address with any third parties.
First Name
Middle Name
Last Name
Last 4 Digits SSN
Birth Month
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February
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July
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November
December
Birth Day
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Street Address 1
Street Address 2
City
State
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Phone
Email Address
Password
Confirm password
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