Free Medical Staff Application Form Template
Medical Staff Application Form
Please fill out the following information to complete your application.
Center for Wilderness Safety takes the safety of its students very seriously. By completing a background check which includes a sexual offense safety check, CWS is able to take extra precautions against potential incidents. Given the nature of the courses taught, all staff must pass both criminal and sexual offender checks in order to be considered for employment with CWS.
By completing and submitting this application, the applicant agrees to a criminal background check as well as a sex offender check. Any offenses against children are considered immediate disqualification to work for CWS.
I Have Taken a CWS Course in the Past*
Full Name
Phone number
Mailing Address
Age
Sex
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Male
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Female
Date of Birth
Race
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Asia/Pacific Islander
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Black
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Indian
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Alaskan Native
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White/Caucasian
Have you ever been convicted of any misdemeanor or felony?*
If yes, please explain:
Current Certifications:
Languages That I'm Fluent In:
Position & Availability
Position (s) Interested
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Instructor -- Wilderness Medicine
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Instructor -- American Red Cross
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Special Event EMS Team Member (VA, DC, MD only)
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Administrative Assistant
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Internship
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Volunteer & Alumni Coordinator
Can you work weekdays?
Can you work weekday evenings?
Can you work weekends?
Can you work holidays?
When can you start?
Experience Questions
Describe your experience with emergency medical care (if any).
Describe your teaching or public speaking background.
Give an example of when you exhibited leadership skills in an outdoor environment.
Briefly explain your outdoor/wilderness skills & abilities.
Do you have any relevant wilderness rescue experience?
Why do you wish to become a Center for Wilderness Safety staff member?
List all professional organizations that you are affiliated with.
References
Please provide two professional and one personal reference. Please do NOT use immediate family or relatives. All references will be checked.
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Resume, Cover Letter & Photo
Cover Letter
Upload Resume
Upload Photo
Comments or Questions
Terms & Conditions
By clicking "Submit", I attest that all of the information enclosed with my employment application is correct to the best of my knowledge and grant the Center for Wilderness Safety permission to contact my references and perform a background check.
Applicant's Signature
Name:
Date:
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