Personal Information |
|
First Name: |
|
Middle Initial: |
|
Last Name: |
|
Date of Birth |
|
Nationality: |
|
Place of Birth: |
|
Age: |
|
Sex: |
|
|
Marital Status: |
|
Telephone (home): |
|
Telephone (work): |
|
Postal Address (work): |
|
Postal Address (home): |
|
Name, Postal Address
& Telephone number of a local contact person: |
|
Medical Degree, College/University Name, Date Degree Obtained: |
|
List of Additional and/or Higher Qualifications with dates: |
|
State type of practice you which to pursue: |
|
Professional References: Name 3 and state full postal address: |
|
Have any proceedings ever been initiated against you in a court of law by a medical licensing authority? (if yes provide details) |
|
|
| |
submit |
Required Documents |
|
| Applicants are advised to submit the following items once registration form is submitted. Be sure to include your name and contact information when submitting required documents: Click here to submit required documents |
* You are requested to upload an unmounted photograph of yourself (Any photo of recent date which provides a good likeness is sufficient)
|
* Notarized Copies of the Medical Qualifications Documents (or original documents to be inspected by the Chairman or the Registrar)
|
* Detailed Curriculum Vitae (including Full Biographical Data, Medical Education and Post-Graduate Training, Post-Graduate Qualifications, Clinical Experience, Employment History and Research work)
|
* Current Certificate of Good Standing issued by the relevant Medical Licensing Authority (original only) attesting as to whether or not the applicant has ever been subject to disciplinary enquiry
|
* Letter from the sponsoring agency stating full purpose of the application
|
N.B. Medical practitioners registered under Section 13c(i), do not have the privilege of private practice in the Bahamas.
FAILURE TO PROVIDE ALL THE ABOVE DOCUMENTS WILL RESULT IN REJECTION OF THE APPLICATION
|
