Get Application For Visiting Resident Or ... - Cleveland Clinic - My Clevelandclinic

This guide provides step-by-step instructions for filling out the APPLICATION FOR VISITING RESIDENT OR OBSERVER at Cleveland Clinic. Designed for users with varying levels of experience, this resource aims to simplify the application process and ensure accurate completion.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the date in the designated field at the top of the form. This indicates when you are completing the application.
3. Specify the application type you are submitting. Provide the name of the service or department you are applying for in the applicable section.
4. Indicate whether you have previously been a visiting observer at Cleveland Clinic Florida by checking 'Yes' or 'No'. If applicable, include the specific dates of your previous visit.
5. Fill in your personal information including last name, first name, middle name, and social security number or passport number. Ensure all details are accurate.
6. Complete your present mailing address, including street, city, state, country, and postal code. You should also provide your permanent mailing address in the specified section.
7. List your contact information by providing the area codes and phone numbers for your home and work, as well as your fax number and email address.
8. Under the education section, list the name and location of your medical school, along with dates of attendance and the degree obtained. Attach a copy of your medical school diploma as required.
9. Document your residency information by including the specialty, hospital, location, and date of completion.
10. Provide details of any other advanced appointments, including the hospital name, location, and dates.
11. Attach your curriculum vitae as requested in the application.
12. In the health requirements section, confirm you provide proof of necessary immunizations and tests, as indicated.
13. If you have a Florida medical license number, indicate 'Yes' and provide a copy of your medical license. Otherwise, check 'No'.
14. Address any limitations that may affect your duties by responding to the corresponding question.
15. If you have a narcotic registry license in Florida, indicate 'Yes' and submit a copy of your DEA certificate. Otherwise, mark 'No'.
16. Answer whether you are a United States citizen and provide the type of visa if applicable.
17. International medical graduates should respond about their certification by the Educational Commission for Foreign Medical Graduates, providing the certificate number and valid through date.
18. After completing the form, confirm the accuracy of the information and sign the application. Include the date of your signature.
19. Finally, save your changes, and consider downloading, printing, or sharing the completed application as required.

Ensure your application is completed accurately and submit it online today.