ROTATING RESIDENT APPLICATION PAGE 2 2026

1. Click ‘Get Form’ to open the ROTATING RESIDENT APPLICATION PAGE 2 in the editor.
2. Begin by entering your name in the designated fields: Last Name, First Name, and Middle Initial. Ensure clarity for accurate processing.
3. Fill in your pager number and email address for communication purposes.
4. Indicate your PGY Level at the time of rotation, along with details about your Base Hospital and Program Coordinator's contact information.
5. Complete the Rotating Hospital section, specifying the department and rotation dates. Clearly state the name of the rotation.
6. Provide information on previous rotations at this institution and check off whether you have ACLS or ATLS certifications, including their expiration dates.
7. Detail your residency history, listing each program with its specialty, location, and duration.
8. Request vacation dates by indicating your first, second, and third choices. Remember that these are subject to approval.
9. Finally, ensure all checklist items are completed before submitting for review by signing where indicated.

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