Glendale Memorial Physician Pre-Application

Thank you for your interest in employment at Dignity Health – Glendale Memorial Hospital. Please fill out this Physician Pre-Application and submit along with the following supporting documentation:

• Copy of current California license to practice medicine
• Copy of government-issued picture ID card (i.e. driver’s license)
• Evidence of Board Certification or active candidacy
• Copy of narcotics registration certificate (DEA certificate)
• Copy of current certificate of malpractice insurance coverage with minimum limit of $1 million per occurrence/$3 million aggregate
• Copy of ECFMG certificate (if foreign medical school graduate)
• Curriculum vitae
• Signature of staff member willing to provide emergency coverage

Please submit via mail, email or fax. Questions? Please call (818) 502-2317.

Mailing Address

Medical Staff Administration
1420 South Central Avenue
Glendale, CA 91204

Email: tbd

Fax: 818.502.4738