Clinical Flight Crew Volunteer Application

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* 1. Name:

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* 2. I reside in

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* 3. Have you volunteered with Haiti Air Ambulance in the past?

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* 4. If yes, when was the last time (month / year) you volunteered with Haiti Air Ambulance?

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* 5. Do you have at least 2 years of rotor wing air medical transport experience?

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* 6. Have you ever, volunteered, worked in, or lived in Haiti in the past?

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* 7. I am

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* 8. How many years experience total do you have with rotor wing air ambulance transport?

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* 9. My current (or most recent) rotor wing air ambulance employer is:

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* 10. Do you have a current Passport this is valid for at least 6 months?

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* 11. If you do not have a current Passport, are you in the process of obtaining one?

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* 12. I can commit to volunteering with Haiti Air Ambulance for a total of ________ days including travel days:

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* 13. I am licensed as a (select all that apply):

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* 14. I am current in the following certifications (select all that apply): 

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* 15. Are you able to (check all that apply):

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* 16. How did you learn of volunteer opportunities with HAA?

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* 17. Briefly explain your interest in volunteering with Haiti Air Ambulance as a clinical flight crew member:

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* 18. What dates would you be available to come volunteer if selected?

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* 19. What is your flight-ready weight in pounds?

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