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Instructor Candidate Screening Form

To be completed by the instructor candidate.

First Name

Last Name

Email Address

Phone Number

Street Address

City

Zip Code

State

What is your current occupation?

What type of instructor are you interested in becoming? (Currently we are only offering BLS and Heartsaver)

BLS

Heartsaver

Do you have any teaching experience?

Yes

No

Have you ever been a CPR instructor?

Yes

No

Why do you want to become an AHA instructor?

How did you hear about Therapeutic Professionals?

Are you currently aligned with an American Heart Association Training Center?

Yes

No

The AHA requires that you align yourself with a training center. Do you want to align yourself with Therapeutic Professionals?

Yes

No

How often do you plan to teach classes?

Several times per week

Once Per Week

Twice Per Month

Occasionally

Do you own manikins with a feedback device?

Yes

No

Will your classes be open to the public?

Yes

No

Do you have a location to teach from?

Yes

No

Select Schedule

By checking this box, you acknowledge that you have answered each question completely and truthfully.

Last Step: Book Your Q&A Session

Thank you for submitting our screening form. You should receive a summary of your responses in a confirmation email – check your spam folder if you do not.

Now, please select a day and time below to book your Q&A Session.

Almost Finished…

Please Select A Day and Time For A Phone Interview

Selected: Please select a day and time you will be available for an interview.