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#19-002589-0003
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***
1.

Do you have a valid EMT or Paramedic certification?
Yes No
2.

Do you possess a current Certified Flight communicator certificate or equivalent certification?
Yes No
3.

Describe your experience managing Emergency Services 911 Dispatchers or Air Medical Communications Specialists. In your description, please include the name(s) of employer(s), dates of employment, and the related job duties performed. If you do not possess this experience, please enter N/A.
4.

Describe your experience in developing and presenting EMS or Air Medical training programs and curriculum. In your description, please include the types of programs and curriculum you developed and presented, the name(s) of employer(s) and dates of employment. If you do not possess this experience, please enter N/A.

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