Instructor Application

Instructor Application
Thank you for your interest in instructing with Codeblue. We’re always looking to connect with skilled and passionate professionals across all disciplines.

Please complete the form below with as much detail as possible. Your submission will be forwarded to the relevant course coordinator, who will review your information and be in touch in due course.
Name*

First NameLast Name
Email*
example@example.com
Mobile Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
IHF Instructor Certificates*

ACLSPALSPEARSBLSNone of the above
ALSG Instructor Certificates*

APLSPLSMIMMSHMIMMSNone of the above
PHECC Instructor Certificates*

CFR-CCFR-AFAREFRPatient MovingNone of the above
ACLS Certificate Number, Expiry Date, Certificate Upload
ACLS Certificate Number*
ACLS Certificate Expiry Date*

DayMonthYear
Date
ACLS Certificate Upload*

Cancelof
PALS Certificate Number, Expiry Date, Certificate Upload
PALS Certificate Number*
PALS Certificate Expiry Date*

DayMonthYear
Date
PALS Certificate Upload*

Cancelof
PEARS Certificate Number, Expiry Date, Certificate Upload
PEARS Certificate Number*
PEARS Certificate Expiry Date*

DayMonthYear
Date
PEARS Certificate Upload*

Cancelof
BLS Certificate Number, Expiry Date, Certificate Upload
BLS Certificate Number*
BLS Certificate Expiry Date*

DayMonthYear
Date
BLS Certificate Upload*

Cancelof
APLS Certificate Number, Expiry Date, Certificate Upload
APLS Certificate Number*
APLS Certificate Expiry Date*

DayMonthYear
Date
APLS Certificate Upload*

Cancelof
PLS Certificate Number, Expiry Date, Certificate Upload
PLS Certificate Number*
PLS Certificate Expiry Date*

DayMonthYear
Date
PLS Certificate Upload*

Cancelof
MIMMS Certificate Number, Expiry Date, Certificate Upload
MIMMS Certificate Number*
MIMMS Certificate Expiry Date*

DayMonthYear
Date
MIMMS Certificate Upload*

Cancelof
HMIMMS Certificate Number, Expiry Date, Certificate Upload
HMIMMS Certificate Number*
HMIMMS Certificate Expiry Date*

DayMonthYear
Date
HMIMMS Certificate Upload*

Cancelof
CFR-C Certificate Number, Expiry Date, Certificate Upload
CRF-C Certificate Number*
CFR-C Certificate Expiry Date*

DayMonthYear
Date
CFR-C Certificate Upload*

Cancelof
CFR-A Certificate Number, Expiry Date, Certificate Upload
CRF-A Certificate Number*
CFR-A Certificate Expiry Date*

DayMonthYear
Date
CFR-A Certificate Upload*

Cancelof
FAR Certificate Number, Expiry Date, Certificate Upload
FAR Certificate Number*
FAR Certificate Expiry Date*

DayMonthYear
Date
FAR Certificate Upload*

Cancelof
EFR Certificate Number, Expiry Date, Certificate Upload
EFR Certificate Number*
EFR Certificate Expiry Date*

DayMonthYear
Date
EFR Certificate Upload*

Cancelof
Patient Moving Certificate Number, Expiry Date, Certificate Upload
Patient Moving Certificate Number*
Patient Moving Certificate Expiry Date*

DayMonthYear
Date
Patient Moving Certificate Upload*

Cancelof
Other Certificate(s) Upload
Certificate(s) Upload*

Cancelof
Enter your comments below (optional)
Should be Empty:

Instructor Application

ACLS Certificate Number, Expiry Date, Certificate Upload

PALS Certificate Number, Expiry Date, Certificate Upload

PEARS Certificate Number, Expiry Date, Certificate Upload

BLS Certificate Number, Expiry Date, Certificate Upload

APLS Certificate Number, Expiry Date, Certificate Upload

PLS Certificate Number, Expiry Date, Certificate Upload

MIMMS Certificate Number, Expiry Date, Certificate Upload

HMIMMS Certificate Number, Expiry Date, Certificate Upload

CFR-C Certificate Number, Expiry Date, Certificate Upload

CFR-A Certificate Number, Expiry Date, Certificate Upload

FAR Certificate Number, Expiry Date, Certificate Upload

EFR Certificate Number, Expiry Date, Certificate Upload

Patient Moving Certificate Number, Expiry Date, Certificate Upload

Other Certificate(s) Upload