Phoenix College Paramedic Education Program `THIS COURSE MEETS TUESDAY/WEDNESDAY/THURSDAY 9AM-1PM AND ONE SCHEDULED SATURDAY PER MONTH Phoenix College will be conducting an open Paramedic Education Program with an emphasis in fire based EMS systems. The program timeline is listed below; all interested parties are encouraged to make application (found at Phoenix College or on PC EMT website). The process will consist of a completed application, and a written test. The written test will be based on the National Standard Curriculum for EMT Basic; any EMT Basic text will suffice as study material. 1202 West Thomas Road Phoenix, Arizona 85013 602-285-7210 Office 602-285-7758 Fax scott.crowley@pcmail.maricopa. edu CAHHEP #600439 AZ BEMS Course#30384 January 5, 2015 February 27, 2015 Applications will be available for interested candidates; deadline for submission is February 27, 2015. Applications may be picked up and submitted at the EMT/Fire Science office at Phoenix College or online at the EMT/FSC. February 27, 2015 10:00 am An informal information session will be held at the Phoenix College located on the campus in the PS Building room 20. Attendance is not required but is strongly encouraged. Candidates and/or training Captains, EMS Chiefs and staff are welcome to attend with potential candidates. During this session program goals, expectations, and strategies for success in the written and oral process will be discussed. March 2, 2015 The written test will be conducted at Phoenix College in the PS Building rm 20 at 9:00 am. The test will consist of 150 questions from the DOT EMT Basic curriculum including multiple choice and scenario based questions. Oral interviews will be scheduled and managed by the applicants sponsored fire department, and/or conducted by the Program Director. All Fire Departments will be asked to submit their candidate s names for the applicant list by March 2, 2015 in order to begin document processing. The course begins August 15, 2015 at Phoenix College through June 2016. It is the policy of Phoenix College and The Maricopa County Community College District to promote equal employment opportunities through a positive continuing program. This means that Maricopa will not discriminate, nor tolerate discrimination, against any applicant or employee because of race, color, religion, gender, sexual orientation, national origin, age, disabled, or veteran status. Additionally, it is the policy of Maricopa County Community College District to provide an environment for each Maricopa job applicant and employee tha R t e i v s i f s r e e d e 1 f 0 r / o 0 m 6/0 s 5 exual harassment, as well as harassment and intimidation on account of an individual's race, color, religion, gender, sexual orientation, national origin, age, disabled, or veteran status.
PARAMEDIC EDUCATION PROGRAM APPLICATION FORM Name: Last First/Middle Current Address: Street City State Zip Code Contact Numbers :( ) ( ) ( ) Home Work Cell Phone or Pager Email Address: Home Work Date of Initial EMT Class: Date of Last Recertification Class: EMT-basic Certification Date: EMT-basic Certification Number: List all colleges/universities and degrees earned: Institution Date of Attendance Degree earned Institution Date of Attendance Degree earned Institution Date of Attendance Degree earned The following courses are preferred: Have you attended a course in ECG recognition: yes/no Date: Grade: Have you attended a course in Pharmacology: yes/no Date: Grade: Name of Fire Agency: Address of Fire Agency: Street City State Zip Code Name of Responsible Training Officer/Chief: Phone: 1
Current Position/Work History Agency Dates of Employment Reason for Leaving Agency Dates of Employment List all Current Certifications and Course Completions Preference will be given to those who work for a Fire Based EMS industry. Below please briefly summarize your prehospital experience in emergency patient care: I UNDERSTAND THAT I MUST BE CERTIFIED AS AN EMT-BASIC AND CURRENTLY CERTIFIED AS AN EMT- BASIC OR IEMT IN THE STATE OF ARIZONA. ALL OF THE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND THAT FALSIFICATION COULD MEAN DISMISSAL FROM THE PARAMEDIC EDUCATION PROGRAM. I FURTHER UNDERSTAND THAT A PREFERENCE FOR ACCEPTENCE IS BEING GIVEN TO ALL CURRENTLY WORKING EMT S AND/OR SWORN APPLICANTS THAT ARE EMPLOYEED WITH FIRE DEPARTMENTS. Signature of Applicant Date Phoenix College (600439) is accredited by the Commission on Accreditation of Allied Health Education Programs (www.caahep.org) upon the recommendation of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP). Include the following items with your application: Copy of your current CPR card (front and back) Copy of your current Arizona EMT-B certification card Documentation of reading score (minimum score of [assest-36] or [compas-70]) Two letters of support from currently certified paramedics and/or supervisor Any transcripts from colleges/universities attended (unofficial transcripts accepted) Completed Physical/Immunization forms Copy of Haz-Mat First Responder Certification, enrollment in (FSC105) or Proof of Transcript All students must also provide a copy of a current Arizona Department of Public Safety Fingerprint ID card and/or current Commercial Driver s License or Concealed Weapons Permit. APPLICATION DEADLINE IS February 27, 2015 AT 4:00PM. Your application may also be mailed to: Phoenix College EMT/FSC Department Paramedic Education Program Attention: Scott Crowley, Program Director 1202 W. Thomas Rd. Phoenix, Az. 85013
Name: SSN # Address: City: State: Zip Code: HAVE YOU HAD OR DO YOU HAVE: YES NO Vision or Hearing problems Heart Problems Childhood diseases Epilepsy, Diabetes, High Blood Pressure, Kidney problems Bone/joint disease or injury, back injury Serious Injuries/Major surgery, Hernias Mental Illness/Nervous Disorder Drug/Alcohol problems Lung disease Skin problems/diseases I hereby certify that this information is true to the best of my knowledge. Student Signature Date
FOR PHYSICIAN USE ONLY PATIENT NAME AGE HEIGHT WEIGHT PHYSICAL EXAMINATION DATE: HEENT: Lungs: Heart: **Pulse: **BP: Abdomen: Extremities/Joints: Neurologic/Mental: **Vision: R L **Corrected: R L (**indicates the numerical assessment must be documented) Based on this physical, do you find any reason why this person cannot physically perform these activities? Yes No If yes, please explain: Name: (Please Print) MD, DO, PA, FNP Signature: Address: City: State: Zip Code:
EMERGENCY MEDICAL TECHNOLOGY IMMUNIZATION RECORD I, Print Name (last, first, MI) Signature give permission to to complete this form and release this information to Phoenix College. DATE: ************************************************************************************************* REQUIRED: 1. Tuberculin Intermediate Skin Test (PPD): (Must be good thru March 2008) Date Result (Optional): Chest X-Ray Date Result 2. One of the following Rubella Titer: Result (German Measles) Rubella Vaccine: Rubeola Titer: Result (Measles) Rubeola Vaccine: M.M.R. Vaccine: 3. Date when you had the Chicken Pox: OR Varicella Titer: Result (Chicken Pox) Varicella Vaccine: 4. Hepatitis Vaccine Series Recommended Phoenix College Emergency Medical Technology/Fire Science (602) 285-7207 FAX (602) 285-7217