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Click here to download the Official 4M Employment Application
Current copies of the following documents must be submitted with this application:
- Curriculum vitae
- State Medical License(s) (wallet card)
- State Controlled Substance License(s)
- DEA Certificate
- Board Certification Verification (if applicable)
- Medical School Diploma
- Internship Certificate(s)
- Residency Certificate(s)
- Fellowship Certificate (if applicable)
- ECFMG (if applicable)
- NCCPA (if applicable)
- ACLS, ATLS, PALS, APLS, BLS, NALS, NRP, or NPRS Certificates
- Current Photo
- Please be advised, because of the demanding needs of malpractice carriers, we now will be requesting a 5-year loss run history from your current and previous malpractice carriers. To obtain this information, contact either your prior insurance companies directly or your prior facilities’ Human Resource/Risk Management Departments.
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