FULL-TIME FACULTY (80-100%)

CLINICAL APPOINTMENT APPLICATION CHECKLIST

ATTACH THIS CHECKLIST TO THE FRONT OF YOUR APPLICATION
NB: Community Affiliated hospitals please use alternate form:
Name of Candidate:
Is this a NEW appointment: £ Yes £ No
(Candidate has never had an appointment with the Department of Psychiatry; this is the first time this applicant will receive a clinical faculty appointment with the Department of Psychiatry.) / Is this a RE-appointment: £ Yes £ No
(Candidate had an appointment with the Department of Psychiatry in the past; however, would like to change status from “inactive’ to “active” and be re-appointed to the Department.)
The following documents are required for a Full -Time Clinical Appointment Application:
R / CHECKLIST / FOR DEPT of PSYCH. USE ONLY
£ / Letter of Support from the Psychiatrist-In-Chief. Please reference the Letter of Support Template for all mandatory information. / £
£ / Letter of Support from the Division Head. / £
£ / CV / £
£ / Certificate of Professional Conduct - Photocopy acceptable. / £
£ / Clinical Appointment Application (MD) / £
£ / Job Description (MD) / £
£ / Profile form / £
£ / Time Commitment Form (MD Full-Time) – Required for applications ONLY at the rank of Assistant Professor, Associate Professor and Professor. NOT required for the rank of Lecturer. / £
£ / 2-3 Internal Letters of Reference – Reference letters should be from individuals WITHIN the applicant’s own teaching unit and/or hospital. / £
£ / 2-3 External Letters of Reference – Reference letters should be from individuals EXTERNAL to the applicant’s hospital site. / £
The following information is mandatory – please complete in full:
SUBMITTED BY (Admin Asst Contact Info): / FOR DEPT of PSYCH. USE ONLY
Name:
Site:
Email:
Phone:
Submission for Academic Appointment MUST be submitted in one COMPLETE package.
The COMPLETE package is to be submitted via email to / Questions may be directed to Theresa (Terrie) M. Oliveira
Email:
Phone: 416-979-4980 Fax: 416-979-6928

Submission Deadline to Department – Second Friday of the Month

October 30, 2012