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Moonlighting (Final Year Specialty Locum ER-GP Locum

Moonlighting (Final Year Specialty Locum ER-GP Locum 2026

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The document is a request form for final year specialty locum positions in various medical fields. It outlines the necessary steps and criteria for learners to apply, including submission deadlines, required approvals from health authorities and CPSNL, and certification requirements. The form also includes sections for personal information, scheduled rotations, and signatures to confirm the accuracy of the provided details.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name, program, and email address in the designated fields. Ensure that your information is accurate for processing.
Indicate your PGY level and CMPA code. If you have a current ACLS certification, select 'Yes' or 'No' accordingly. Note that certain specialties require this certification.
Fill in the scheduled rotation details at the time of locum, including location and any relevant dates and times using the 24-hour clock format.
Complete the section for requesting division head/site chief by providing their name and signature.
If applicable, indicate any annual leave requests ensuring it does not compromise your rotation requirements.
Finally, certify that all information is correct by signing and dating the form before submission.

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