Create Mintfm Application - RumcAdmissionCentral

First name

Last name

Nric

Email

NRIC Front and Back

Dob

Age

Gender

Race

Son of Soil (Bumi Putera)

Marital Status

Phone Number

Please enter your phone number in the Malaysian's format 012-3456789.

Street Address

Postal Code

City

State

Country

Malaysia Medical Council (MMC) Registration Number

MMC Registration Date

Complete Medical Degree

Awarding institution

Current UD Grade

Permenent Resident

I'm a Non-Permenent Resident

Current MOH Posting

Moh Posting

I'm a MOH Posting

Current Workplace

Name

Entry Date

Graduation Date

Qualification

Country

Overall Grade

Medical Degree Certificate

Medical Degree Transcript

Information

Only Include your most recent working experience related to medical field. Hospital or Klinik Kesehatan KK

First Medical Institution Experience

Name

Department

Start Date

End Date

Post specialization

Educational supervisor

Gap reason

Second Medical Institution Experience

Name

Department

Start Date

End Date

Post specialization

Educational supervisor

Gap reason

Annual Practicing Certificate (APC)

Expiry Date

Certificate File

Declaration One - MInTFM PERSON SPECIFICATION

I confirm that I have read and understand the entry criteria as listed in the person specfication of the MInTFM for Family Medicine Trainee. I declare that my present experience makes me eligible to commence training with respect to the entry criteria listed in Malaysia.

Accepted

Declaration Two - POLICE

I declare that I have not at any time been convicted (i.e. probation, fine, sentence, penalty) of a criminal offence (e.g. assault, public order, sexual assault) in Malaysia and/or in any other jurisdiction nor are there any charges relating to criminal offences

Accepted

I have never been the subject of a Caution or Bound over order. I accept that making a false or misleading declaration may render any offer of a training position as null and void.

Accepted

Date of Investigation

Country of Investigation

Police Court Outcome

Declaration Three - TRAINING SCHEME

I declare that I currently am not nor was I the subject of an investigation by any professional medical training body or its equivalent in Malaysia and/or in any other jurisdiction. I accept that making a false or misleading declaration may render any offer of a training position as null and void.

Accepted

Date of Investigation

Organization

Training Scheme Outcome

Declaration Four - DRIVING LICENSE

I confirm that I must possess a full valid drivers license and have access to a vehicle for work purposes at my own expense, so that I may continue to fulfil the above requirement.

Accepted

I don't have

Declaration Five - MEDICAL COUNCIL

I accept that making a false or misleading declaration may render any offer of a training position as null and void.

I declare that I am not nor have I been the subject of any investigation by a medical registration or licensing body or authority in any jurisdiction with regard to my medical practice or conduct as a practitioner.

Accepted

I have not been suspended from registration, nor had any restrictions on practice nor had my registration or license cancelled or revoked by any medical registration or licensing body or authority in any jurisdiction nor am I the subject or any current suspension or any restrictions on practice.

Accepted

Date of Investigation

Country of Investigation

Medical Council License Body

Medical Council Outcome

Declaration Six - MENTAL HEALTH FITNESS

I declare that I'm mentally fit and stable with adequate coping skill. I have not undergone any Psychiatric treatment.

Accepted

I accept that making a false or misleading declaration may render any offer of a training position as null and void.

Accepted

Information

You will be offered a place based on your ranking in interview scores and in order of your preferences. There will be a maximum limit for spaces allocated in each scheme. You must all schemes.

Please rank in order of preference (1-most preferred to 4-least preferred).

First Scheme

Second Scheme

Third Scheme

Fourth Scheme

Referee info

You will be asked to submit details of two supervising consultants who will provide you with a reference. One of these referees must be your present / most recent specialist or supervising consultant; the other must be from a supervising consultant with whom you have worked within the last three years.

Referees from other posts such as lecturing/tutor posts will not be accepted. References for same post / time period but different supervising consultant are not accepted. Please confirm the name, job title and address of your two referees. References will be uploaded in advance of the interview using a standardized form. Details of this will be included in the interview invitation.

Applicants who have completed a post in Family Medicine should include a reference from that FMS. Note: MInTFM reserves the right to use references to preclude offers being made if the reference submitted is deemed to be unsatisfactory.

Note: Information or referees are required , ONLY if you are shortlisted for interview.

I, the applicant, understand that I am personally responsible for ensuring that all submitted data and supporting documentation is accurate, legible and attached to the application form by the closing date of 15 December 2025. Failure to do so may result in the rejection of my application.

I confirm that I have read and fully understand the terms and conditions in making any application for postgraduate Family Medicine Training (MlnTFM).

I understand that I also must apply to Bahagian Pengurusan Latihan (BPL) to be eligible for training in July.