Section II - Work History/Professional Affiliations

Do not "refer to attached cv"

Please list CHRONOLOGICALLY (since completing training) all professional activities, paid or volunteer, self-employment, service as an independent contractor (including Locums agencies), and/or any healthcare entities OTHER THAN THE HOSPITALS listed in the Hospital Affiliations section. If you need additional space, please use a separate piece of paper and upload:

Any gap of greater than 60 days in chronology requires an explanation:

Military History

Are you a member of the reserves?