Register As Physician

Thank you for applying to the Manitoba Locum Tenens Program. The first step in the process is to completing the application below. Please allow up to 10 days for your registration to be completed. Once submitted your credentials will be verified and you will be notified of acceptance into the Manitoba Locum Tenens Program Pool of Physicians.

The following documentation will be required prior to acceptance.

  • Certification that Locum Physician is fully licensed and registered to practice medicine in the province of Manitoba
  • Proof of membership in good standing with the Canadian Medical Protective Association
  • Certified copy of Medical Degree
  • Certified copy of LMCC
  • Certified Copy of Advanced Cardiac Life Support (ACLS) and Advanced Trauma Life Support (ATLS)
  • Each Locum Physician will be required to sign an Independent Contractor Medical Service Agreement with the Manitoba Locum Tenens Program outlining the Program and Physician responsibilities.

* = required

Personal Information
Physician First Name:
Physician Last Name:
What languages do you speak fluently? English    French    Other
Billing Number:
Desired Schedule Type:
Desired Workplace Regions:   
  
  
  
  
  Specific Facility
Contact Information
Address:
City:
Province:
Postal Code:
Phone 1:   ext. 
Phone 2:   ext. 
Phone 3:   ext. 
Email 1:
Email 2:
Medical Services Information
    By clicking on this check box, I am signifying that I maintain a valid license and I am eligible to practice medicine in the province of Manitoba.
Certifications:   PALS     ACLS     ATLS     CMPA     Other
CPSM#:
CCFP#:
Medical School:
MD Year:
Specialty:
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Describe Medical Skillset:
Physician Questions
When you are not working for the MLTP will you maintain a practice elsewhere?
How did you initially find out about the MLTP?   Word of Mouth
  Conference
  Regional Recruiter
  Social Media
  Manitobalocum.ca website
  Other
What factors influenced your decision to work within Manitoba?   Family
  Location Environment
  Change and Variety
  Financial reward
  Learning opportunities
  Other
What motivated you to register with the MLTP?   Location
  Break routine
  Gain new perspective
  Expand my horizons
  Expand CV
  Freedom
  Flexibility
  Network
  Share
  Contribute
  Income
  Other
Are you doing locums as a means to explore full-time practice opportunities?
Curriculum Vitae
Upload Curriculum Vitae:
*.pdf, *.doc, *.docx, *.txt, *.rtf @ 1Mb Maximum
Account Information
User ID:
Password:
Confirm Password:
 

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