Please read it carefully, complete it accurately, and return all materials, in person, to the address on the cover letter.
|
|
- Cameron Nigel George
- 5 years ago
- Views:
Transcription
1 August 6, 2015 Dear EMT Student Applicant: We applaud yur desire t investigate becming an Emergency Medical Technician (EMT). Our agency has ver 35 years experience prviding EMS t the Twn f Friday Harbr, San Juan Island and the islands f Brwn, Stuart, Jhns, Speiden, Pearl and Henry. We functin as a municipal third service 9-1-1, tax supprted EMS/MedEvac system under the San Juan Cunty Public Hspital District N. 1 serving the residents and visitrs f ur district as well as the waterways and ther nn-ferry served islands f San Juan Cunty when requested. We are natinally accredited using a mixed prvider mdel with award winning patient satisfactin and natinally certified/recgnized leadership. Yu will need t purchase EMT bks (abut $250, reimbursed at the cmpletin f the class) and attend all training, cmplete all hmewrk, practical classes, and sessins. The EMT curse begins Nvember 4, 2015 with mandatry prerequisites cmpleted befre the class start date. This curse requires attendance f all scheduled Wednesday nights and Saturday days thrugh April, Ttal curse includes 190 instructin hurs and requires additinal individual study and practice time. This packet will help yu navigate the applicatin prcess. Please read it carefully, cmplete it accurately, and return all materials, in persn, t the address n the cver letter. Persnnel are generally in the ffice Mnday t Thursday during nrmal business hurs. A subset f all applicants will be scheduled fr an interviews/agility test. The prcess is highly cmpetitive and will include the written applicatin, physical agility exam and current immunizatin recrd, criminal/driving, drug and emplyment backgrund checks. Questins abut this prcess can be directed t Weyshawn Kns r Cady Davies at training@sanjuanems.rg r by phne at Student candidates will be selected based n multiple criteria including, but nt limited t, applicatin materials, examinatin scres, test results, backgrund checks, gegraphical lcatin, ability t respnd t calls, and face t face interviews. Successful acceptance int the EMT class des nt guarantee a psitin as an EMT with San Juan Island EMS and MedEvac upn cmpletin f the curse. COMPLETED APPLICATION DUE MONDAY, SEPTEMBER 14, 2015 BY 5 PM AT PHYSICAL ADDRESS BELOW. Fr further infrmatin, please g nt the web at We wish yu success in yur applicatin.
2 Minimum Requirements t Apply We value yur time and interest. Yu will need t meet ALL f the fllwing criteria: 1. Willing t cmplete all aspects and requirements f the class. 2. Full-time, permanent resident f San Juan Island with the expectatin t remain a full-time resident fr the next tw years fllwing graduatin. 3. Able t d a physically and emtinally difficult jb f prviding care t acutely ill and injured peple, in dangerus situatins, requiring quick and clear thinking with physical dexterity and strength r lder (due t insurance requirements). 5. High schl graduate r GED. 6. Nt becme a member f any ther public safety agency while a student r during yur first year past prbatin because f the extensive training and rientatin requirements. 7. Be legally emplyable in the United States. 8. Valid Scial Security Number and pssess a valid Washingtn State Driver License with less than 6 pints and n cnvictins fr DUI. 9. N felny cnvictins that wuld prevent yu frm becming certified with the State f Washingtn. 10. Free frm addictin t any prescribed, recreatinal, and/r illegal drugs r substances. We have a zer tlerance plicy. 11. Be able t cmmit and cmplete the entire curse with a willingness t then apply t becme an EMT with ur agency with full supprt frm yur immediate family. 12. Serve a minimum f tw years past the initial prbatinary perid r repay San Juan Island EMS the amunt f $2,500 fr the cst f the training. 13. Submit t a physical examinatin including drug screening exam prvided at the cst f the district. 14. Underg a thrugh criminal backgrund and driver check thrugh available law enfrcement inquiries. 15. Purchase yur textbks which cst apprximately $250 (reimbursed at the end f yur prbatinary perid upn cmpletin). 16. Becme a certified Wilderness EMT within 2 years f cmpleting prbatin. (Wilderness training prvided by the agency). 17. Cmplete all ther requirements t maintain yur status as an active EMT. 18. Pssess a genuine caring fr the residents and visitrs in ur cmmunity and act prfessinally and with cncern fr peple s safety and privacy at all times. I recgnize that this is an applicatin fr entrance int the EMT class nly and nt an applicatin fr emplyment r vlunteering with San Juan Island EMS and MedEvac. I agree t pay fr the cst f my bks befre class begins. Having read the abve, I, agree t fulfill the requirements and submit t the terms f reimbursement fr self-selected early terminatin r terminatin frm the curse with cause. Signature f Applicant Date Witness Date
3 Checklist (T Be turned in with Applicatin) Applicant Name: Meet Minimum requirements Cmpleted Applicatin with signatures and witness signatures Cpy f High schl diplma r GED Cpy f Valid Scial Security Card Cpy f Washingtn State Driver License Cmpleted Backgrund Check Waiver with witness signatures Immunizatin Frm Cmpleted
4 Basic Demgraphic Infrmatin TODAY S DATE DATE TURNED IN NAME LAST FIRST MIDDLE ADDRESS MAILING Physical Address (IF DIFFERENT) ADDRESS: TELEPHONE_(hme) (cell) DATE OF BIRTH / / SOCIAL SECURITY NO. (Attach a legible cpy) CURRENT WA STATE DRIVERS LICENSE NO. Exp. Date: (Attach a legible cpy) D yu have any physical r psychlgical prblems that culd affect yur ability t perfrm the wrk f an EMT? YES NO WOULD YOU BE ABLE TO SIGN UP FOR MULIPLE 6 HOUR SHIFTS PER MONTH? DAYS ONLY NIGHT AND DAY SEASON DEPENDENT NIGHTS ONLY CERTAIN DAYS OF THE WEEK D yu have any past medical experience? If yes, please explain. Are yu currently affiliated with any ther public safety agency r vluntary cmmunity grup(s)? In 100 wrds r less, tell us why yu want t becme an EMT with San Juan Island EMS. (Use back if necessary)
5 Criminal/Driving Backgrund Waiver and Release TODAY S DATE : I, d hereby authrize San Juan Island EMS and MedEvac t btain cmplete driver, educatinal, military service, prir licensing, wrk recrds, and criminal recrds and histries and any ther infrmatin cncerning my previus emplyment r vlunteering. This may include but nt limited t WATCH, NCIC, San Juan Cunty Sheriff Recrds, Military Discharge Recrds, State and Federal recrds, emplyment recrds, vlunteering recrds, and educatinal recrds. I hereby release all parties and persns cnnected with any request fr infrmatin frm all claims, liabilities, and damages fr whatever reasn arising ut f such infrmatin gathering r infrmatin received. NAME LAST FIRST MIDDLE ADDRESS MAILING Physical Address (IF DIFFERENT) TELEPHONE DATE OF BIRTH / / SOCIAL SECURITY NO. (Attach a legible cpy) CURRENT WA STATE DRIVERS LICENSE NO. (Attach a legible cpy) Signature f Applicant Date Witness Date
6 Immunizatin Recrd fr San Juan Island EMS and MedEvac Name: Date f Birth: Please fill in the dates fr all yur current immunizatins yu have received in the apprpriate space given belw. IMMUNIZATIONS REQUIRED BEFORE CLASS STARTS: (Applicant Respnsibility) If yu dn t knw when yur last MMR was, yu may get a MMR titer (which is an immunity test) TDAP MMR #1 MMR#2 MMR Titer result MMR BOOSTER IMMUNIZATIONS REQUIRED DURING r AFTER CLASS: (Prvided by Agency) TB TEST Hep B #1 Hep B #2 Hep B#3 Hep B Titer (HBsAb) Hep B Bster Flu Sht OTHER IMMUNIZATIONS YOU MAY HAVE RECEIVED: Name Date: I, state that the fllwing recrds are accurate and up t date. I understand that further dcumentatins may be requested by San Juan Island EMS.
7 Signature Date EMT Student Candidate Physical Agility (Fr Infrmatin Only) Pre evaluatin candidate fr Heart Rate, Bld Pressure, Respiratins and Warm up. Stage 1: Equipment Carry Maximum time 5 minutes The candidate is t carry 1 fully stcked medical bx (pelican case), 1 cardiac mnitr, and 1 airway bag (n back) up and dwn 3 stries f stairs safely. Candidate is allwed t set dwn equipment 1 time (max 5 secnds) withut pint deductin. Time begins when the Candidate lifts equipment ff flr. Nte: Airway bag can be pre-psitined as backpack. Lifting and carrying begins as sn as the 5 minutes is up r candidate is ready whichever is first. Each piece f gear is less than 30 lbs. each. Stage 2: Lifting and Carrying Task 1: N time limit Candidate will be paired with an EMT partner (able t cmplete all EMS related physical tasks) and will be required t mve rescue manikin, 185 lbs. frm seated psitin t stair chair and up ne stry and dwn the stairs safely. Task 2: Candidate will be paired with same EMT partner t package patient nt backbard using spider straps. Tw mre EMT s r Firefighters will arrive t assist in lifting patient and carrying up tw flights f stairs then place the patient dwn and switch carrying ends befre cntinuing dwn tw flights f stairs safely. Patient will then be placed n ct and laded int the ambulance. Nte: Candidate will carry either head f patient r ft f backbard. EMT skills are nt required fr this statin. EMT partner will instruct and assist. Mid evaluatin f candidate HR, BP, RR Stage 3: Rescue Mannequin Drag 2 minutes maximum Candidate will pick up the 185 lb. mannequin by squatting dwn and reaching arund the rescue mannequin with bth arms under the mannequin s arm pits. The candidate will then drag the mannequin 10 feet and set the mannequin dwn gently. The time will start when the mannequin s buttcks are ff the grund and time will stp when the candidate and the mannequin bth crss the line. The candidate may stp t repsitin hands but must nt drp the mannequin. Stage 4: Cardi Walk 15 minutes maximum The candidate will walk a distance f 1 mile with a weighted vest f 25 lbs. Cl dwn perid San Juan Island Fitness and Xteme Fitness have bth been made aware f the requirements f the candidate test requirements and may be a resurce, if yu desire. Any cst r use f these facilities r services is strictly vluntary and is nt required prir t the exam. During all lifting evlutins, any unsafe actins will result in failure.
Resident Assistant Application
Resident Assistant Applicatin 2017-2018 We are excited that yu have decided t apply t be a Resident Assistant (RA). It is a unique pprtunity t wrk with diverse grups f students and be actively invlved
More informationResident Assistant Application
Resident Assistant Applicatin We are excited that yu have decided t apply t be a Resident Assistant (RA). It is a unique pprtunity t wrk with diverse grups f students and be actively invlved n the Queens
More informationBoston University. Advocate Applicant Information Packet Spring Tony Kushner
Bstn University The wrld is calling; heal the wrld and in the prcess heal yurself, find the human in yurself by finding the citizen, the activist, the her. Tny Kushner Advcate Applicant Infrmatin Packet
More informationVOLUNTEER SERVICES APPLICATION PACKAGE
VOLUNTEER SERVICES APPLICATION PACKAGE Applicatin Checklist Applicatin Frm Letter fr Criminal Recrd Check Vlunteer Reference Frm Infrmatin abut Immunizatins Infrmatin fr High Schl students VOLUNTEER SERVICES
More informationFrequently Asked Questions RN Program
Revised March 2013 Frequently Asked Questins RN Prgram 1. What are the pre-requisites t the RN prgram? The applicant must meet the requirements listed belw befre admissin t the clinical nursing curses
More informationObtain an official copy of your PN transcript to submit with this packet.
Advanced Placement Packet fr LPNs fr Spring 2018 Deadline fr packet submissin: 11/16/17 It is pssible t receive credit fr yur LPN experience and begin the RN prgram at Crning Cmmunity Cllege. Advanced
More informationADMISSION REQUIREMENTS
Revised June 2015 fr Applicatin Perid Fall 2015 Frequently Asked Questins LPN - RN Prgram LPN s interested in the LPN-RN transitin have the same pre-admissin & general educatin requirements as generic
More informationAGENCY NAME - Crisis Stabilization Services
AGENCY NAME - Crisis Stabilizatin Services Prgram Statement Crisis stabilizatin services are prvided t children and adlescents ages 6-17 that have symptms and current presentatin that requires skilled
More informationPractical Nursing Program Information (Revised March 2018)
Practical Nursing Prgram Infrmatin (Revised March 2018) Prgram Descriptin: The Practical Nursing (PN) Prgram prepares individuals t practice under the supervisin f a registered nurse, licensed physician
More informationMedical Assistant Program Western Technical College. Supplemental Information
Medical Assistant Prgram Western Technical Cllege Supplemental Infrmatin Curse Sequence and Delivery. This is a tw-term prgram. During the first term, the student cmpletes the basic r fundatinal curses.
More informationCommunity Health Worker / Certified Recovery Specialist Training Application
APPLICANTS REQUIRED TO COMPLETE APPLICATION WITHOUT ASSISTANCE FROM OTHERS $35 Applicatin Fee is nn-refundable Applying des NOT guarantee admissin int training Date f Applicatin: First Name: Last Name:
More informationOdessa College Associate Degree Program Admissions Guide
Odessa Cllege Assciate Degree Prgram Admissins Guide Cntact Infrmatin: Directr: Jackline Sireng; jsireng@dessa.edu; 432-335-6627 Student Success Cach: Advising@dessa.edu; 432-335-6433 Secretary: Linda
More informationAPA Title Program. Information Booklet
APA Title Prgram Infrmatin Bklet This wrk is cpyright. Apart frm any use as permitted under the Cpyright Act 1968, n part may be reprduced by any prcess withut permissin frm the Australian Physitherapy
More informationA retired employee or past employee who was employed full-time by a governmental entity in Broward County continuously for at least five years.
2017 2018 SCHOLARSHIP APPLICATION RALPH H. AND RUTH FRANK GROSS MEMORIAL SCHOLARSHIP Ralph and Ruth Frank Grss understd the value f a gd educatin. This schlarship was established in memry f them and is
More informationAPPLICATION FOR REGISTERED NURSING PROGRAM FALL 2017 (Filing deadline: February 10, 2017, 4:00 PM) PLEASE TYPE OR PRINT NEATLY
APPLICATION FOR REGISTERED NURSING PROGRAM FALL 2017 (Filing deadline: February 10, 2017, 4:00 PM) PLEASE TYPE OR PRINT NEATLY NOTE: N student may enrll in the Nursing Prgram unless he/she is admitted
More information1901 Pediatric Acute Emergency Medicine
Curse: Pediatric Acute Emergency Medicine Curse Number: PED 1901 Department: Faculty Crdinatr: Assistant Faculty Crdinatrs: Pediatrics David Rdriguez, MD N/A UTSW Educatin Crdinatr Cntact: Anthny Lee (Anthny.Lee@UTSuthwestern.edu)
More informationIHSS In Home Support Services
IHSS In Hme Supprt Services What is IHSS? The IHSS prgram is a statewide mandated prgram administered by each cunty under the directin f the Califrnia Department f Scial Services. It prvides thse with
More informationThe information and instructions below are for College of Business Administration [Departmental] Scholarships only.
COLLEGE OF BUSINESS ADMINISTRATION DEPARTMENTAL SCHOLARSHIPS Cllege f Business Administratin departmental schlarships are available t business majrs in all cncentratins and are awarded t Business students
More informationAccelerated Bachelor of Science in Nursing. Fall 2018 Application Packet
Accelerated Bachelr f Science in Nursing Fall 2018 Applicatin Packet WCU nursing faculty and staff welcme yur applicatin fr admissin t the Accelerated Bachelr f Science in Nursing (ABSN) Prgram. This applicatin
More informationGuide to Complete the Steps for Foreign-Trained Nurses to Obtain the Maryland Registered Nurse (RN) License
Guide t Cmplete the Steps fr Freign-Trained Nurses t Obtain the Maryland Registered Nurse (RN) License Welcme Back Center Suburban Maryland Mntgmery Cunty, Maryland Department f Health and Human Services
More informationFLORIDA CHILD CARE DIRECTOR CREDENTIAL AND RENEWAL APPLICATION
FLORIDA CHILD CARE DIRECTOR CREDENTIAL RENEWAL APPLICATION RESOURCE PAGE A directr credential is required fr each licensed child care facility and Vluntary Pre-Kindergarten (VPK) Prgram. The directr credential
More informationCAMPBELL COUNTY GILLETTE, WYOMING
CAMPBELL COUNTY GILLETTE, WYOMING Cmmunicatins Technician I Cmmunicatins Technician II Cmmunicatins Technician III Class specificatins are intended t present a descriptive list f the range f duties perfrmed
More informationNightingale Healthcare Professionals
Nightingale Healthcare Prfessinals Phne: (510) 553-1800 Fax: (510) 553-1818 Email: inf@nightingalehealthcareprfessinals.cm Website: www.nightingalehealthcareprfessinals.cm NURSING ASSISTANT TRAINING PROGRAM
More informationPractical Nursing Program Information
Practical Nursing Prgram Infrmatin Prgram Descriptin: The Practical Nursing (PN) Prgram prepares individuals t practice under the supervisin f a registered nurse, licensed physician r dentist. Use f the
More informationDirections & Instructions for Filing an Application to the Radiologic Technology Program
2018 Radilgic Technlgy Applicatin Infrmatin Page 1 f 7 Ls Angeles City Cllege Radilgic Technlgy Prgram APPLICATION INFORMATION PACKET Applicatin Filing Perid is February 1, 2018 t March 31, 2018 Directins
More informationQuincy University Grants Development & Management Guide
1 Quincy University Grants Develpment & Management Guide Intrductin The Office f University Advancement versees the grants prcess at Quincy University and is yur resurce fr seeking funding frm any external
More informationSIVB Learning Session 1. Patient and Family Perspectives and their connection to Increasing the Vaginal Birth Rate
SIVB Learning Sessin 1 Patient and Family Perspectives and their cnnectin t Increasing the Vaginal Birth Rate The Assignment: Patients cme t ur units t deliver their babies with a range f needs, expectatins,
More informationInstructions. Important Dates. Application Deadline: May 15, 2013 at 5:00 p.m. Grant Awards Announced: July 15, 2013
Instructins Imprtant Dates Applicatin Deadline: May 15, 2013 at 5:00 p.m. Grant Awards Annunced: July 15, 2013 Prject Cmpletin: December 31, 2014 CONTACT: Lancaster Cunty Cnservancy Fritz Schreder PO Bx
More informationSUMMER 2018 BACCALAUREATE TO ASSOCIATE DEGREE NURSE ACCELERATED PATHWAY APPLICATION
SUMMER 2018 BACCALAUREATE TO ASSOCIATE DEGREE NURSE ACCELERATED PATHWAY APPLICATION GENERAL INFMATION ABOUT OCCC HEALTH PROFESSIONS PROGRAMS Thank yu fr yur interest in ur health prfessins prgrams at Oklahma
More informationCareer Mobility Program
Revised Nvember 2016 Cllege f the Redwds Health Occupatins (707) 476-4216 7351 Tmpkins Hill Rad (707) 476-4419 (Fax) Eureka, CA 95501-9300 www.redwds.edu/departments/h/index.asp Career Mbility Prgram The
More informationPatient Instructions for Home Medical Equipment
Patient Instructins fr Hme Medical Equipment In rder fr ABC Health Care t cmplete the request fr yur prescribed hme medical equipment, we will need the fllwing dcumentatin requirements cmpleted in full
More informationLSU HEALTH SHREVEPORT NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
LSU HEALTH SHREVEPORT NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
More informationChronic Disease Self-Management Program (CDSMP) Evidence-based Chronic Disease Self-Management Program for Older Adults
Chrnic Disease Self-Management Prgram (CDSMP) Evidence-based Chrnic Disease Self-Management Prgram fr Older Adults Prgram Apprved by AA, CDC, and NCOA Web Site http://patienteducatin.stanfrd.edu/prgrams/cdsmp.html
More informationFinancial Officer 18 Applicant Inventory
Financial Officer 18 Applicant Inventry Frequently Asked Questins Why has an applicant inventry been created t fill Financial Officer 18 vacancies? The creatin f applicant inventries allws fr a mre cnsistent
More informationSERVICES COVERED BY PHP FamilyCare
SERVICES COVERED BY PHP FamilyCare PHP FamilyCare cvers the same services that Medicaid des. Cverage is nt available unless the service is medically necessary. Cverage is als nt available unless the service
More informationHoward County General Hospital Proposes Construction Project to Serve Growing Community New addition would add necessary treatment space
Hward Cunty General Hspital Prpses Cnstructin Prject t Serve Grwing Cmmunity New additin wuld add necessary treatment space COLUMBIA, Md. Hward Cunty General Hspital (HCGH) is prpsing a campus cnstructin
More informationAnnual South Carolina School Health LPN of the Year Award ( )
Annual Suth Carlina Schl Health LPN f the Year Award (2017-2018) The SC Schl Health LPN f the Year Award is presented annually by the SC Department f Health and Envirnmental Cntrl and the SC Department
More informationREGIONAL ARTS FUND Quick Response Grant
REGIONAL ARTS FUND Quick Respnse Grant Intrductin The Reginal Arts Fund is an Australian Gvernment prgram that supprt sustainable cultural develpment in reginal and remte cmmunities in Australia. The prgram
More informationMANUAL SURGE CAPACITY PROTOCOL
MANUAL St. Mary's Hspital Camrse, Alberta PURPOSE Initiated by: Number: ER-7290 Apprved by: Date First Issued: May 24, 2016 Date f Last Revisin: Nv 5, 2008 Categry: Emergency Ref Plicy #: Tpic: SURGE CAPACITY
More informationDepartment of Teacher Education Tentative Admission
Department f Teacher Educatin Tentative Admissin Requirements Must have cmpleted a minimum f 60 cllege credit hurs Minimum GPA f 2.75 Minimum cmpsite scre (r super scre) f 20 n the ACT Cmplete the Missuri
More informationWHAT IS CAL MEDICONNECT? Cal MediConnect is a health plan that combines all of the benefits you now get from Medicare and Medi-Cal into a single plan.
Last updated: 3/8/2016 5:25 PM DO YOU HAVE BOTH MEDICARE AND MEDI-CAL? Intrductin If s, yu may be eligible t jin a Cal MediCnnect health plan. WHAT IS CAL MEDICONNECT? Cal MediCnnect is a health plan that
More informationUSS ALABAMA CREWMATE CONTEST
2018-2019 USS ALABAMA CREWMATE CONTEST USS ALABAMA CREWMATE CONTEST Thursday, MARCH 21, 2018. Interviews will be held abard the Battleship and begin at 9:00 am. All applicants must be present frm 9:00
More informationGRANT APPLICATION. Sustainable Agricultural Land Strategy Grants SUSTAINABLE AGRICULTURAL LANDS CONSERVATION PROGRAM
SUSTAINABLE AGRICULTURAL LANDS CONSERVATION PROGRAM Sustainable Agricultural Land Strategy Grants GRANT APPLICATION Strategic Grwth Cuncil Califrnia Natural Resurces Agency Califrnia Department f Cnservatin
More informationResident Assistant Application 2018
Resident Assistant Applicatin 2018 We are excited that yu have decided t apply t be a Resident Assistant (RA). It is a unique pprtunity t wrk with diverse grups f students and be actively invlved n the
More informationYOUTH What is Heads Up Football? What are the benefits of a youth football organization adopting Heads Up Football?
YOUTH What is Heads Up Ftball? Heads Up Ftball is a USA Ftball rganizatinal membership prgram designed t create a better, safer game. Key cmpnents f this prgram include caches cmpleting the nly natinally
More informationDOCUMENT TITLE: Clarification of Bureau of Primary Health Care Credentialing and Privileging Policy outlined in Policy Information Notice
2002-22 DATE: July 10, 2002 DOCUMENT TITLE: Clarificatin f Bureau f Primary Health Care Credentialing and Privileging Plicy utlined in Plicy Infrmatin Ntice 2001-16 TO: Cmmunity Health Centers Migrant
More informationBlack Country BeActive Partnership Inspired Coaches Application Form
Black Cuntry BeActive Partnership Inspired Caches Applicatin Frm Guidance Ntes Please visit www.blackcuntrybeactive.c.uk fr guidance n Funding aims Wh can apply? Hw are applicatins assessed? Payment (Payment
More informationABI Forum of the CT Community Nonprofit Alliance
Date: January 16, 2017 ABI Frum f the CT Cmmunity Nnprfit Alliance T: The Hnrable Representative Abercrmbie Frm: Julia Wilcx, Senir Public Plicy Specialist, CT Cmmunity Nnprfit Alliance (The Alliance)
More informationAcademic and Career Advisement Center Jacobetti Center Office 103 Jacobetti TUTOR APPLICATION
Jacbetti Center Office 103 Jacbetti TUTOR APPLICATION Recmmended by Faculty: Name: Address: NMU Student Number: Declared Majr: Date: Phne: E-mail: NMU GPA: STATUS (circle ne): Freshman Sphmre Junir Senir
More informationBADNAP: Prospective Baccalaureate to ADN Accelerated Pathway Nursing Student. Dear Student:
BADNAP: 07 17 Prspective Baccalaureate t ADN Accelerated Pathway Nursing Student Dear Student: Thank yu fr yur interest in the Baccalaureate t ADN Accelerated Pathway f the Assciate Degree Nursing Prgram
More informationTerminating the Provider- Patient Relationship. Provided by Coverys Risk Management
Terminating the Prvider- Patient Relatinship Prvided by Cverys Risk Management Terminating the Prvider-Patient Relatinship What s the Risk? An allegatin f abandnment may be brught against a prvider if
More informationA Grant Program for Neighborhood Residents
Lve My Neighbr! Example Grant Applicatin A Grant Prgram fr Neighbrhd Residents At Neighbrhd Allies, we believe n ne knws ur cmmunities as well as thse wh live in them. If yu are a resident and have an
More informationSAMPLE- Visit FirehouseSubsFoundation.org to apply online. Firehouse Subs Public Safety Foundation Grant Application
SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. Firehuse Subs Public Safety Fundatin Grant Applicatin 1 SAMPLE- Visit FirehuseSubsFundatin.rg t apply nline. Cngratulatins! Yur rganizatin has met Firehuse
More informationLoyola University Health System NURSING DEPARTMENT EDUCATION STIPEND GUIDELINES
Lyla University Health System NURSING DEPARTMENT EDUCATION STIPEND GUIDELINES Please fllw these guidelines when submitting an applicatin fr cnsideratin f funds frm the Nursing Department Educatin Stipend
More informationHealth Career Academy and Scholarship Program Dignity Health/Dominican Hospital and Cabrillo College Academic Year
Dignity Health/Dminican Hspital and Cabrill Cllege Academic Year 2013-2014 Are yu planning a career in the health ccupatins? Have yu taken at least ne pre-requisite curse fr an Allied Health prgram, OR,
More informationYes, USERRA Applies to 12304b Duty
LAW REVIEW 17110 1 Nvember 2017 Yes, USERRA Applies t 12304b Duty By Captain Samuel F. Wright, JAGC, USN (Ret.) 2 Update n Sam Wright 1.1.3.1 USERRA applies t vluntary service 1.1.3.3 USERRA applies t
More informationVantel Pearls International, Inc. 46 Eastman Street, South Easton, MA Tel Compensation Plan.
Vantel Pearls Internatinal, Inc. 46 Eastman Street, Suth Eastn, MA 02035 www.vantelpearls.cm Tel. 508.698.2220 (March, 2016) Welcme t Vantel Pearls! This dcument prvides an verview f the incme, benefits,
More informationH-1B PETITION EMPLOYEE QUESTIONNAIRE
H-1B PETITION EMPLOYEE QUESTIONNAIRE SUPPORTING DOCUMENTS CHECKLIST Please email the fllwing dcuments t Office f Internatinal Prgrams as scanned clr cpies. Cmpleted H-1B Emplyee Questinnaire Please als
More informationBEHAVIORAL HEALTH STAFF COVERAGE PROTOCOL. Psychiatrist and Psychologist Coverage Plan...4. Telemedicine.7
BEHAVIORAL HEALTH STAFF COVERAGE PROTOCOL Scial Service Prvider Cverage Plan. 2 Psychiatrist and Psychlgist Cverage Plan.....4 Telemedicine.7 1 SOCIAL SERVICE PROVIDER COVERAGE PLAN In situatins where
More informationClient and Health Coach Support System
Client and Health Cach Supprt System HOW TO USE THE CLIENT AND HEALTH COACH SUPPORT SYSTEM HOW TO USE THE CLIENT & HEALTH COACH SUPPORT SYSTEM The Client and Health Cach Supprt System is an rganized way
More informationMedical Conditions Policy
Lxtn Preschl Centre Medical Cnditins Plicy Medical Cnditins Plicy NQS QA2 2.1.1 Each child s health needs are supprted. 2.1.4 Steps are taken t cntrl the spread f infectius diseases and t manage injuries
More informationSEQOHS Accreditation Assessor Job Description
SEQOHS Accreditatin Assessr Jb Descriptin Abut this Dcument This dcument supprts the SEQOHS Office prcess fr the recruitment f assessrs fr the SEQOHS accreditatin scheme. Assessrs must be frm an ccupatinal
More informationFor purposes of this Security Agreement, the use of the terms you and your includes both the Oil and Gas Operator and the EFA when appropriate.
Oil and Gas Operatr and Electrnic Filing Administratr (EFA) Registratin and Security Agreement fr Oil and Gas Electrnic Filing Systems Oil and Gas Operatr (Primary Reprting Entity) Name f Oil and Gas Operatr:
More informationUCLan Careers: Our Statement of Service to UCLan Students and Graduates
UCLan Careers: Our Statement f Service t UCLan Students and Graduates Intrductin Our Statement f Service sets ut what yu are entitled t expect frm UCLan careers and what standard f prvisin yu shuld receive.
More informationOregon Registry. Infant Toddler Professional Credential. Overview. Oregon Center for Career Development in Childhood Care and Education
Oregn Registry Infant Tddler Prfessinal Credential Overview Oregn Center fr Career Develpment in Childhd Care and Educatin March 2011 Oregn Center fr Career Develpment in Childhd Care and Educatin SETTING
More informationEach Home Instead Senior Care franchise office is independently owned and operated Home Instead, Inc.
Each Hme Instead Senir Care franchise ffice is independently wned and perated. 2010 Hme Instead, Inc. The nrmal aging prcess, which may invlve sensry lss, decline in memry, and slwer prcessing f infrmatin
More informationMATH, SCIENCE & HEALTH PROFESSIONS NURSING PROGRAM NURSING 121. Spring 2014
MATH, SCIENCE & HEALTH PROFESSIONS NURSING PROGRAM NURSING 121 Curse Infrmatin and frms Spring 2014 Student Name: Reviewed and revised 1/2014 1 NRS 121 - WEEKLY SCHEDULE (This is just a brief verview fr
More informationCouncil Camp Staff and the Annual Health & Medical Record. CampDoc FAQs
Cuncil Camp Staff and the Annual Health & Medical Recrd CampDc FAQs What is CampDc? CampDc.cm is an electrnic health recrd system designed by physicians, nurses, and camp directrs fr use in camps. Web-based
More informationDenver Public Schools. Financial Services. Financial Services Manual. Grants
Denver Public Schls Financial Services Financial Services Manual Grants Table f Cntents Grants... 3 Prcedures GRC Website... 3 Step by Step Guide... 4 Federal Grants... 7 Title I... 7 Title II... 8 Time
More informationThe Bureau of EMS is working with our ESF 8 partners to provide an opportunity for performance based
Bbby Jindal GOVERNOR State f Luisiana Department f Health and Hspitals Bureau f Emergency Medical Services Bruce Greenstein SECRETARY Octber 19, 2010 Dear Clleague, The Bureau f EMS is wrking with ur ESF
More informationSmart Energy GB in Communities Fund Small grants. Grant Guidelines May 2016
Smart Energy GB in Cmmunities Fund Small grants Grant Guidelines May 2016 0 What can I d nw? Befre yu apply fr funding make sure yu have lked at the free resurces available. Yu can start using these immediately.
More informationSafety in Practice Compliance and Risk Assessment Procedure January, 2017
Safety in Practice Cmpliance and Risk Assessment Prcedure Safety in Practice Cmpliance and Risk Assessment Prcedure January, 2017 Cntents 1 Objectives... 2 2 Scpe... 2 3 Safety in Practice Cmpliance and
More informationProspective Traditional Nursing Student
TRN: 07-17 Prspective Traditinal Nursing Student Dear Student: Thank yu fr yur interest in the Assciate Degree Nursing Prgram at Oklahma City Cmmunity Cllege. The OCCC nursing prgram has cntinued full
More informationThe member must be offered the opportunity to be seen immediately or within 30 minutes.
Befre cmpleting the Practitiner Data Frm fr Beacn Health Optins, Inc. (Beacn), frmerly ValueOptins, please review the fllwing criteria required fr netwrk practitiners. Nte: These check-ff sheets are prvided
More informationTourism Events Grants. FY 2019 (July 1, 2018 June 30, 2019)
CITY OF PRESCOTT 201 S. Crtez St. Presctt, AZ 86303 928-777-1220 www.visit-presctt.cm Turism Events Grants FY 2019 (July 1, 2018 June 30, 2019) POLICIES, PROCEDURES and CRITERIA Dear TAC Grant Applicant:
More informationInterested individuals should submit their application, curriculum vitae, and letter of recommendation on or before March 31, 2018.
This is a fillable frm. Please dwnlad this pdf, cmplete the frm electrnically, save it t yur cmputer, and email the dcument t nminatins@nbcrna.cm. EMERGING LEADER FELLOWSHIP The NBCRNA is seeking applicants
More informationEMPLOYEE INNOVATION GRANTS (EIG)
EMPLOYEE INNOVATION GRANTS (EIG) The Center fr Innvatin supprts creative excellence and celebrates ideas that inspire change, transfrmatin and prfessinal develpment fr all SLCC emplyees. Emplyee Innvatin
More informationSmall Business. Big Recognition.
Small Business Develpment Center Small Business. Big Recgnitin. The Small Business Develpment Center knws firsthand that small businesses are the backbne f American free enterprise. Every day, they re
More informationAbout this guide 5 Section 1: Meeting VET sector requirements 7
Cntents Abut this guide 5 Sectin 1: Meeting VET sectr requirements 7 1.1 Hw Aspire s resurces assist in meeting requirements 7 1.2 Resurce quality assurance prcesses 16 Sectin 2: Unit f cmpetency infrmatin
More informationCommunity Development Small Grants Fund. Guidelines 2018
Cmmunity Develpment Small Grants Fund Guidelines 2018 This fund is pen t charitable nt-fr-prfit cmmunity welfare grups whse primary clientele cme frm within Palmerstn Nrth City Cuncil (PNCC) bundaries.
More informationProspective Baccalaureate to ADN Accelerated Pathway Nursing Student The
BADNAP: 07 18 Prspective Baccalaureate t ADN Accelerated Pathway Nursing Student Dear Student, Thank yu fr yur interest in the Baccalaureate t ADN Accelerated Pathway f the Assciate Degree Nursing Prgram
More informationSincerely, Encl: Health Careers Application; EMT Program Application
Dear Prspective Emergency Medical Technlgy Student, Thank yu fr yur interest in the Emergency Medical Technlgy (EMT) prgram at Cuyahga Cmmunity Cllege (Tri C ) where futures begin. Our prgram is accredited
More informationGuidelines for Analysis of Credentials to be Included on COOL
Guidelines fr Analysis f Credentials t be Included n COOL Relatedness Determinatin Guidelines Relatedness Determinatin (RD) refers t the identificatin f certificatins relevant t a Navy rating/designatr/ccupatin.
More information2018 SCHOLARSHIP/INTERNSHIP APPLICATION DALLAS HISPANIC LAW FOUNDATION
2018 SCHOLARSHIP/INTERNSHIP APPLICATION DALLAS HISPANIC LAW FOUNDATION SCHOLARSHIP GUIDELINES: The Dallas Hispanic Law Fundatin awards schlarships and bar study grants t wrthy Hispanic law students. Applicatins
More informationMONASH Special Developmental School
MONASH Special Develpmental Schl CRITICAL INCIDENT POLICY 1. RESPONDING TO A TRAUMATIC OR CRITICAL INCIDENT IN WHICH THE SCHOOL IS INVOLVED The schl may becme directly r indirectly invlved in a tragic
More information2018 HBS New Venture Competition Student Social Enterprise Track
2018 HBS New Venture Cmpetitin Student Scial Enterprise Track Details fr Participating Teams KEY DATES See details fr each n fllwing pages Date January 31, 2018 12:00 nn February 21, 2018 12:00 nn March
More informationSecurity Force Assistance Brigade (SFAB) Frequently Asked Questions (V.1)
Security Frce Assistance Brigade (SFAB) Frequently Asked Questins (V.1) 1. What is a Security Frce Assistance Brigade (SFAB)? - The Army s newest unit designed specifically t cnduct security frce assistance
More informationResidential Mental Health Treatment for Children and Adolescents
Residential Mental Health Treatment fr Children and Adlescents Requirement: Frequency: Due Date: Chapter 394, F.S. Sectin 39.407, F.S. Fla. R. Juv. P. 8.350 Chapter 65E-9, F.A.C. Chapter 65E-10, F.A.C.
More informationEd Bak ProgramManager, Emergency MedicalTechnology 2900 Community College Ave-MHCS 126H Cleveland, OH
Dear Prspective Emergency Medical Technlgy Student, Thank yu fr yur interest in the Emergency Medical Technlgy (EMT) Prgram at Cuyahga Cmmunity Cllege Where Futures Begin. The prgram is accredited by the
More informationEXPLANATORY NOTES. (applicable from 1 July 2015) STAGE 1 DESKTOP ASSESSMENT. for the RECOGNITION OF OVERSEAS OCCUPATIONAL THERAPY QUALIFICATIONS
Phne: +61-8-9368 2655 GPO Bx 959 Suth Perth WA 6951 Website: www.tcuncil.cm.au E-mail: admin@tcuncil.cm.au ABN 50 377 833 627 EXPLANATY NOTES (applicable frm 1 July 2015) STAGE 1 DESKTOP ASSESSMENT fr
More informationPatient Instructions for Home Medical Equipment
Patient Instructins fr Hme Medical Equipment In rder fr ABC Health Care t cmplete the request fr yur prescribed hme medical equipment, we will need the fllwing dcumentatin requirements cmpleted in full
More informationRESPIRATORY THERAPY PROGRAM
Dear Applicant: VIRGINIA BEACH CAMPUS RESPIRATORY THERAPY PROGRAM Thank yu fr yur interest in the Respiratry Therapy prgram ffered n the Virginia Beach Campus f Tidewater Cmmunity Cllege. Successful graduates
More informationVoluntary Pre-Offer Self-Identification of Protected Veteran Status
Vluntary Pre-Offer Self-Identificatin f Prtected Veteran Status This emplyer is a Gvernment cntractr subject t the Vietnam Era Veterans' Readjustment Assistance Act f 1974, as amended by the Jbs fr Veterans
More informationRe- Defining Physician Credentialing Software A New Approach
Sftware A New Apprach The upcming reimbursement shift frm fee fr service t fee fr quality has generated an increased fcus n ppulatin health management. In rder t ensure a sufficient clinical delivery base,
More informationBulletin. Required Activity: Admission to Medicaid-Certified Nursing Facilities and 90-day Redetermination TOPIC PURPOSE CONTACT SIGNED
Bulletin NUMBER #17-25-06 DATE August 7, 2017 OF INTEREST TO Cunty Directrs Scial Services Supervisrs and Staff Tribal Health Directrs Lng Term Care Cnsultatin Cntacts Nursing Facility Prviders Hspital
More informationTraining & Conferences Manager Job Description and Person Specification
Training & Cnferences Manager Jb Descriptin and Persn Specificatin Backgrund The Bat Cnservatin Trust (BCT) is prud t be the leading nn-gvernmental rganisatin devted slely t the cnservatin f bats and their
More informationGovernment Equalities Office Returners Fund
Gvernment Equalities Office Returners Fund Overview In the Spring Budget 2017, the Prime Minister cmmitted 5 millin t prmte returnships t the public and private sectrs, helping peple back int emplyment
More informationEngaging in End of Life Conversations with Patients and Families: A Four Part Series
Engaging in End f Life Cnversatins with Patients and Families: A Fur Part Series Part One: General Explratin f End f Life Optins We receive training and build skills thrughut ur careers that allw us t
More information2018 SEASONAL CAMP STAFF APPLICATION
2018 SEASONAL CAMP STAFF APPLICATION Opprtunities t serve scuting as a member f a seasnal camp staff are available t utstanding applicants. Cmpetitin fr emplyment is keen; the jb is demanding; the experience
More informationSECTION A: Patient s name: Last: First: MI: Date of birth: Phone number: Medical Record Number:
Stanfrd Health Care (SHC) Stanfrd, CA 94305 Phne: 650-723-5721 HEALTH INFORMATION Page 1 f 6 AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION When yu cmplete and sign this frm, health
More information