Thank you for your interest in our medical training program! The information you provide in this survey will help us determine your eligibility. A response will be sent to the email address you provide in question 2.

A response is required for every question. Please answer the question that is being asked.

Please note: All selected applicants must be able to pass a level 2 background screening.

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* 1. Please enter your name.

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* 2. Please enter your email address and phone number.

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* 3. Which certification are you interested in?

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* 4. What are your primary reasons for pursuing this certification? (Select all that apply)

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* 5. How did you hear about our workforce development program?

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* 6. Do you currently work in the medical field?

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* 7. Do you have any previous experience in the medical or healthcare field? If yes, please describe.

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* 8. Are you currently employed?

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* 9. Are you able to provide proof of having a high school diploma or GED?

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* 10. Do you have any prior certifications or degrees? If yes, please list.

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* 11. Employment in the medical field typically requires passing a Level 2 Background screening. Are you able to pass a level 2 background screening?

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* 12. What are your long-term career goals in the healthcare field?

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* 13. Why do you believe you are a good candidate for this program?

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* 14. Do you currently face any of the following barriers to employment? (Check all that apply)

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* 15. Do you have reliable transportation to attend in-person training sessions?

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* 16. The training may include additional costs (e.g., school uniform, TB testing, and supplies) estimated at >$100. Do you have the resources to cover these costs?

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