Medical Staff Application Form

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

Email

    Phone number

      Mailing Address

      Age

      Sex

        • Male

        • Female

        Date of Birth

        Race

          • Asia/Pacific Islander

          • Black

          • Indian

          • Alaskan Native

          • White/Caucasian

          Have you ever been convicted of any misdemeanor or felony?*

          If yes, please explain:

            Current Certifications:

              CPR/AED - AdultCPR/AED - Healthcare Provider (Professional Level)Lifeguard (Red Cross or Ellis)First ResponderEMT-BEMT-IPAMDAmerican Red Cross InstructorCPR/AED - Child, InfantStandard First AidWilderness First Aid (WFA)Wilderness First Responder (WFR)WEMTEMT-PRN/LPN/BSNAmerican Heart Association Instructor

              Languages That I'm Fluent In:

                EnglishSpanishGermanFrenchChineseJapaneseHindiOther

                Position & Availability

                Position (s) Interested

                  • Instructor -- Wilderness Medicine

                  • Instructor -- American Red Cross

                  • Special Event EMS Team Member (VA, DC, MD only)

                  • Administrative Assistant

                  • Internship

                  • 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.

                                Name

                                Company

                                Relationship

                                Phone Number

                                Email

                                Name

                                Company

                                Relationship

                                Phone Number

                                Email

                                Name

                                Company

                                Relationship

                                Phone Number

                                Email

                                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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                                Thank you for submission!

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