APPLICATION FORM - ANESTHESIA TECHNOLOGY INTERNSHIP PROGRAM


 Click to Select Photo
* Marked is Mandatory

*
*
Full Name (as per passport)
 
Address
*
P.O. Box
*
 
City
*
Country
*
 
Phone No. *
Email Address
*
 
Nationality
*
Gender
*
 
Valid passport with valid UAE visa
*
 
(For U.A.E nationals: Family Book)
*
 
Valid Emirates ID
*
 
Birth Certificate
*
 
Date of Birth
Visa Status
 
Provisional Degree
 
Year of Graduation
Degree Awarding Institute
Degree Attested
 
Transcript
 
CV
*
 
Valid BLS & ACLS Provider Certificates
 
Malpractice Insurance
 
2 Letters of Recommendation
*
 
Letter of Good Standing
 
(BCG, HBV, Haemophilus influenzae type B vaccine, Tetanus)
 
 
P.O - Box : 4184 - Ajman, UAE.
-
Phone: (+971 6) 7431333
-
Fax: (+971 6) 7431222

© 2015 Gulf Medical University - Ajman, U.A.E. All rights reserved.