icncheader

Application for ICNC's 2012 EMT Training Course
Required Required Question(s)

Before applying, please review information on the contents and the requirements of the EMT training course at www.industrialcouncil.com.

In brief, this course is an intensive training program funded by the Eleanor Foundation, taught by Superior Ambulance and offered through KIDC (nonprofit arm of ICNC). Ambitious, hard working, single women from Chicago seeking an opportunity to advance their professional & personal lives are encouraged to apply.

Training starts in March 2012. Classes are held every Saturday from 9AM to 4PM through December 2012.

 

 

 

 

All EMT students are required to:

       *Study 2-4 hours per day 
       *Successfully pass all exams & maintain a minimum 80% overall average
       *Be in proper uniform for all class times and associated class sessions
        (navy polo, navy pants & black work boots) 
       *Possess & maintain a high level of professionalism at all times
        (punctuality, proper attire, & code of conduct)
       *Schedule & complete all ambulance ride/clinical times outside of
         scheduled class times
       *Attend & participate in group study
      
Applications will be reviewed on an ongoing basis. Please get yours to us as soon as possible.

Application process and timeline:
      *Oct-Jan   Applications accepted online
      *Jan-Feb   Assessment and interview period
      *March  EMT Mandatory pre-course session begins (CPR)
      *April   EMT Class starts
      *Dec 15th  Graduation date (tenative)

 

 

 

 
Required 1.

Have you visited our website and read the requirements of the EMT Training Course?

YES
NO
Required 2.

How did you hear about the EMT training course?

Radio
Flyer
Email
Referral from former EMT student at ICNC
Heartland Alliance
The Cara Program
Instituto Del Progreso Latino
Center for Working Women
Alderman's office
Hospital or Medical Center
Other  
3.

Please enter the information indicated below.


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 4.

Gender

Female
Male
Required 5.

What is your marital status?

Single
Married
Separated, divorced or widowed
Other  
Required 6.

Are you currently employed? Please include  below your
    1)current (or last) position
    2) the name of your employer
    3) length of time worked  

YES
NO
  • Comment:

  • 500 characters left.
Required 7.

How much do you estimate you earned last year from your employment only?

Less than $10,000
$10,000 - $20,000
$20,000 - $25,000
$25,000 - $30,000
$30,000-$35,000
$35,000-$40,000
More than $40,000
Other  
  • Comment:

  • 500 characters left.
Required 8.

Have you been convicted of a misdemeanor or felony?

YES
NO* also check if record has been legally expunged
  • Comment:

  • 500 characters left.
Required 9.

What's the highest level of education you have received?

Less than High School
High School Diploma or GED
Some College or Associates Degree
Undergraduate Degree
Some Graduate Work
Graduate Degree or Higher
Required 10.

Do you have any experience in the medical field? (experience not required)

YES, please explain below
NO
  • Comment:

  • 500 characters left.
Required 11.

Attendance is mandatory. Are you available every Saturday from March 3rd - December 15th,  2012?

 

 

 

YES
NO
  • Comment:

  • 500 characters left.
Required 12.

This course will be taught in English. Are you fluent in English?

YES
NO
Required 13.

Do you have childcare available on Saturday?

YES
NO
Not Applicable (No childcare necessary)
  • Comment:

  • 500 characters left.
Required 14.

Are you interested in full-time or part-time employment?

Full Time
Part Time
Required 15.

Do you have a valid drivers license?

YES
NO, Never had a drivers license
NO, but have substantial driving experience and the ability to obtain a license
  • Comment:

  • 500 characters left.
Required 16.

Do you have a good driving record?

YES
NO
Not Applicable
Required 17.

In general Emergency Medical Services is a zero tolerance field. Are you able to pass a drug test?

YES
NO
Required 18.

Do you have any physical restrictions?

YES - Please explain below
NO
  • Comment:

  • 500 characters left.
Required 19.

Heavy lifting is required during training. Are you able to lift up to, at minimum, 75 pounds?

YES
NO
Required 20.

Have you ever experienced difficulty (fainting, nausea, vomiting, etc) from any of the following? Check all that apply.

Blood
Feces
Emesis (vomit)
Bodily fluids
Foul odors
None of the above
Other  
Required 21.

Please check all support services you might benefit from while in our training program.

Legal Services (obtainment of child support, custody, landlord issues, etc)
Housing assistance (eg. housing subsidies-*must qualify by income, locating housing)
Access to public health services
Financial education assistance (credit counseling, budgeting, bank accounts, etc)
Counseling (physical, sexual, emotional abuse, domestic violence assistance)
Other  
  • Comment:

  • 500 characters left.
Required 22.

Would you be willing to join an EMT study group? Check all that apply.

Neighborhood study groups
Week nights at ICNC
Online
Downtown locations
I am not able to join a study group
Other  
  • Comment:

  • 500 characters left.
Required 23.

List your two primary strengths and two primary weaknesses.

 

  • 350 characters left.
Required 24.

Would you be interested in training beyond the EMT level? Please check all the apply.

Paramedic
Nurse
Physician
Firefighter
Police Officer
Other  
Required 25.

What type of materials do you like to read? (check all that apply)

Newspapers
Novels
Other fiction
Nonfiction
Read rarely
Read never
Other  
Required 26.

On a scale from 1 - 5, with 1 being the lowest and 5 being the highest, please rate your interpersonal skills.  Explain why.

 Weakest Strongest 
Interpersonal skills level
  • Comment:

  • 500 characters left.
Required 27.

What do you look for in a medical professional?

 

  • 350 characters left.
Required 28.

Referring to the questions above, do you think you have those qualities? Why or Why not?

 

  • 350 characters left.
Required 29.

Have you ever dealt with a medical emergency before?

YES, please explain below
NO
  • Comment:

  • 500 characters left.
Required 30.

Where would you like to be in 5 years?

 

  • 50 characters left.
Required 31.

Please tell us why you would like to become an Emergency Medical Technician.

 

  • 1000 characters left.