Unique ID Are you a member of Al-Kindi Hospital staff? Yes No Residency Program(Required)Select An OptionGeneral SurgeryAnesthesia and intensive careObstetrics and GynecologyName(Required) First Middle Last Family Gender(Required) Male Female Date of Birth(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone(Required)✓ Valid number ✕ Invalid numberConnected to WhatsApp✓ Valid number ✕ Invalid numberEmail Address(Required) City AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Nationality Graduated University(Required) Jordanian Non-Jordanian Graduated Year(Required)Select An Option201020112012201320142015201620172018201920202021202220232024University Grade(Required)Select An OptionExcellentVery GoodGoodFairweakHigh School Grade(Required)Required DocumentsPersonal photo(Required) Drop files here or Select files Max. file size: 5 MB, Max. files: 1. National Identity(Required) Drop files here or Select files Max. file size: 5 MB, Max. files: 2. Certificate of no criminal Drop files here or Select files Max. file size: 5 MB. Valid High School certificate(Required) Drop files here or Select files Max. file size: 5 MB, Max. files: 1. Bachelor's Certificate(Required) Drop files here or Select files Max. file size: 5 MB, Max. files: 1. M.O.H License(Required) Drop files here or Select files Max. file size: 7 MB. Jordanian Medical Association (JMA) Registration(Required) Drop files here or Select files Max. file size: 7 MB. ValidCV(Required) Drop files here or Select files Max. file size: 5 MB, Max. files: 4. Related Medical Experience Certificates Drop files here or Select files Max. file size: 10 MB, Max. files: 6. AdditionalNoteConsent(Required) I agree toI confirm that the all files and information attached above are complete and correct. I authorize the hospital to verify them according to the instructions and regulations in the hospital, and I sign on all the above.Signature(Required)HiddenExam DateHiddenExam Date(Required) DD slash MM slash YYYY HiddenExam Time(Required) Hours : Minutes AM PM AM/PM HiddenExam Result(Required)HiddenInterview DateHiddenInterview Date(Required) DD slash MM slash YYYY HiddenInterview Time(Required) Hours : Minutes AM PM AM/PM HiddenInterview Result(Required)HiddenFinal resultHiddenFinal result
