RESIDE Program Application Form

Please note: To apply to the RESIDE Program, you must already have applied for a full-time family medicine position on Doctor Jobs Alberta in a RESIDE-eligible community.

RESIDE Application Form

"*" indicates required fields

Demographics

Name*

First Last

Email*

Residential Address*

Street Address Address Line 2 City Province / Territory Postal Code Country

Phone*

Date of Birth*

Residency Education

Canadian university through which you completed or are completing your family medicine residency training*

Date of residency completion*

Are you in an R3 year of enhanced skills training?*

Yes

Identify the type of enhanced skills in which you are pursuing training.*

Expected date of enhanced skills training completion*

Rural Alberta Family Medicine Position

To complete the RESIDE application, you must have applied for a family medicine position in a RESIDE-eligible community. Please visit https://doctorjobsalberta.albertahealthservices.ca to apply. The list of RESIDE-eligible communities can be found at rhpap.ca/programs-services/RESIDE/communities. Once you have applied for a position, please return to complete your RESIDE application.

Have you applied for a currently-posted RESIDE-eligible, full-time family medicine position in Alberta via https://doctorjobsalberta.albertahealthservices.ca?*

The list of RESIDE-eligible communities can be found at rhpap.ca/programs-services/RESIDE/communities/.

Yes

Job position number*

In what Alberta community is the position located?*

Did you apply for more than one RESIDE-eligible position?*

Yes

Job position number*

In what Alberta community is the position located?*

Did you apply for more than two RESIDE-eligible positions?*

Yes

Job position number*

In what Alberta community is the position located?*

Consent and Communications

How did you hear about the RESIDE Program? Select all that apply:*

RhPAP e-newsletter

RhPAP website

RhPAP presentation

RhPAP staff

Social media

Conference or event

Stakeholder email message

Word of mouth

Other

If you selected "Stakeholder email message," from whom did you receive this email?*

If you selected "Social media," please specify the social media channel(s)*

If you selected "Conference or event," please provide details*

If you selected "Other," please specify*

If you haven't already done so, are you interested in subscribing to RhPAP's e-newsletters to keep informed on other RhPAP programs and services?

Yes

Please enter the email address at which you would like to receive RhPAP's e-newsletters if it is different than the one you provided earlier.

This field is for validation purposes and should be left unchanged.

RESIDE Program

RESIDE Application Form

Demographics

Residency Education

Rural Alberta Family Medicine Position

Consent and Communications

Consent to Collect, Use and Disclose Personal Information

Please Read Carefully

The Purpose of Collection, Use and Disclosure

Personal Information Subject to Consent

Withdrawal of Consent

Waiver, Release and Indemnity Agreement

Please Read Carefully

Questions?