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#1018-RH0224-01
Supplemental Questionnaire

Last Name
First Name
 

This position requires possession of certification in Advanced Cardiac Life Support (ACLS)

Do you possess a current certification in Advanced Cardiac Life Support (ACLS)?  If yes, identify the date the certification was issued and when it expires.

Note: You must provide a copy of the certificate to be considered for this position.

1
Please describe your administrative or management experience in an emergency medical or trauma field. Please include your scope of responsibility and your role in the organization.
2

Describe your knowledge of and experience with registry programs for trauma, cardiac, and stroke.

3
Describe your education related to this position. Include degrees, courses of study and certificates.
4

Describe your experience writing project reports, documenting investigations, or preparing research findings.

5
Describe your experience establishing, implementing and monitoring professional or clinical standards.