Personal Information

If you are a current MSF Rider Coach who has recently relocated to South Carolina, please complete the survey below.  Rider Coaches who are new to SC will also need to complete a phone call and orientation module with the SC Rider Education program before being referred to one of the colleges.  Each college has their own hiring process and completion of this process does not guarantee employment with one of the colleges. 

First Name:

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* 1. First Name:

Last Name

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* 2. Last Name

Address:

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* 3. Address:

Email Address:

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* 4. Email Address:

Cell Phone:

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* 5. Cell Phone:

Home Phone:

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* 6. Home Phone:

MSF RiderCoach Number:

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* 7. MSF RiderCoach Number:

MSF Certification Date

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* 8. MSF Certification Date

Date
Current Employer:

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* 9. Current Employer:

Are you 18 years of age or older?

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* 10. Are you 18 years of age or older?

Are you CPR certified?

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* 11. Are you CPR certified?

If you are CPR certified, when does your certification expire?

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* 12. If you are CPR certified, when does your certification expire?

Are you First Aid certified?

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* 13. Are you First Aid certified?

If you are First Aid certified, when does your certification expire?

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* 14. If you are First Aid certified, when does your certification expire?

How many classes have you taught this past year?

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* 15. How many classes have you taught this past year?

How far are you willing to travel to coach?

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* 16. How far are you willing to travel to coach?

How many courses have you taught for each certification?

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* 17. How many courses have you taught for each certification?

Which MSF certifications have you obtained?

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* 18. Which MSF certifications have you obtained?

Do you have any questions about the SC Rider Education program?

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* 19. Do you have any questions about the SC Rider Education program?

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