FHTC Instructor Online Application
IMPORTANT - PLEASE READ!!!!The facilities that we are partnered with REQUIRES all teachers to have frequent Covid testing and be FULLY VACCINATED prior to attending clinicals unless you have a documented medical or religious exemption. IF YOU HAVE NOT RECEIVED THE VACCINATION, DO NOT HAVE PLANS ON RECEIVING THE VACCINATION OR DO NOT HAVE SUPPORTING DOCUMENTATION FOR AN EXEMPTION, DO NOT COMPLETE THIS APPLICATION!
Have you received the Covid Vaccination?
*
Yes
No
Do you have proof of receiving the Covid Vaccination?
*
Yes
No
Do you have documentation of a medical or religious exemption?
*
Yes
No
Instructor Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Indiana
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mobile Number
*
Primary Email
*
example@example.com
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
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2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Male
Female
N/A
Are you a citizen of the United States?
*
Yes
No
Are you at least 18 years of age?
*
Yes
No
Is English your primary language?
*
Yes
No
If English is NOT your primary language, have you taken any ESL (English as a Second Language) classes?
*
Yes
No
Driver's License Number (no dashes)
*
Social Security Number (Required for background check) *If you do not have a SSN, enter all 1's. You MUST have a SSN or Authorization to Work in the USA!
*
Race (Required for Background Check)
*
State of Birth (Required for Background Check)
*
Country of Birth (Required for Background Check)
*
How did you hear about Faith Healthcare Training Center
*
Which Social Media platform do you use most often? Facebook, Instagram, or Twitter
*
Have you ever been convicted of a felony or any other crime?
*
Yes
No
If yes, please include specific information including the date of felony charge, nature of felony, which court and final outcome. Submit copies of the court documentation is available.
Do you have any physical condition(s) or any other condition(s) which would limit your ability to perform essential job-related functions?
*
Yes
No
If yes, specify those restrictions or accommodations
Did you graduate from high school?
*
Yes
No
High School Name / Graduation Date / City and State
Did you obtain a GED or equivalent education?
*
Yes
No
Not applicable
Program Name / Completion Date / City and State
Did you graduate from college?
*
Yes
No
College Name / Graduation Date / City and State
Additional Comments (if any)
Submit Application
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