Have you been recruited to fill a position with INSERT FACILITY NAME

Are you a graduate of an accredited school of medicine, osteopathy, or dentistry and have you satisfactorily completed an approved postgraduate residency training program, or an accredited college or professional school?

Are you currently licensed? *If no, you will need to provide evidence that application for licensure has been made during the credentialing process.

Federal DEA License with an address? (If appropriate for your specialty) *If no, you willl need to provide evidence application for change of address has been made during the credentialing process.

Are you Board certified OR admissible to the examination process, in the specialty for which you are requesting privileges?

Have you actively practiced in your specialty (an average of at least 20 hours per week) for 18 of the previous 24 months, or have you completed a residency program or a fellowship within the previous 18 months?

Have you ever been arrested and/or convicted of a felony?