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#20-004421-0002
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.***


1

Please describe your experience receiving, relaying and dispatching medical information from an emergency medical communication system as an operator or from the field as a pre-hospital care provider. In your description, include the name(s) of employer(s), dates of employment and job duties performed. If you do not have this experience, please enter N/A.

2

Please describe your experience as an Emergency Service 911 Operator or dispatcher. In your description, please include the job duties performed, the name(s) of employer(s) and dates of employment. If you do not possess this experience, please enter N/A.

3

Please describe your experience as an EMT level field provider or a higher level (Paramedic).  In your description, include the name(s) of employer(s), dates of employment and job duties performed. If you do not have this experience, please enter N/A.

4

Please describe your experience coordinating medevac helicopter activity including receiving calls, requesting service, assigning and dispatching appropriate aircraft, monitoring aircraft for flight safety, and notifying hospitals. If you do not have this experience, please enter N/A.


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