Instructor Candidate Screening Form
Instructor Candidate Screening Form
Instructions: To be completed by the instructor candidate.
First Name
*
Last Name
*
Full Name
Billing Address Street 1
*
City
*
State
*
Postal Code
*
Cell Phone
*
Email
*
example@example.com
What type of instructor are you interested in becoming? (Currently we are only offering BLS and Heartsaver)
*
BLS
Heartsaver
Do you have any teaching experience?
*
Yes
No
If yes, what experience?
*
Have you ever been a CPR instructor?
*
Yes
No
Who were you a CPR instructor with?
*
Please Select
American Heart Association
American Red Cross
National Safety Institute
ASHI
Other
What training center were you a CPR instructor for?
*
Why do you want to become an AHA instructor?
*
How did you hear about Therapeutic Professionals?
*
Are you currently aligned with an American Heart Association Training Center?
*
Yes
No
What AHA training center are you aligned with and do you intend to stay?
*
The AHA requires that you align yourself with a training center. Do you want to align yourself with Therapeutic Professionals
*
Yes
No
If no, please provide the training centers name in which you're going to align.
*
Please upload your application from that training center.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How often do you plan to teach classes?
*
Several times per week
Once per week
Twice per month
Occasionally
Do you own manikins with a feedback device?
*
Yes
No
Will your classes be open to the public?
Yes
No
Do you have a location to teach from?
*
Yes
No
*
By checking this box, you acknowledge that you have answered each question completely and truthfully.
Submit Candidate Screening Form
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