Fillable Paramedic Application 2019 LCCC Paramedic Program Application 2019

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Paramedic Application 2019 LCCC Paramedic Program Application 2019

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WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
2019 Paramedic Program Applicant Checklist
Questionnairecomplete?
Applicationcomplete?
Two lettersofreference? (May be sent separately)
Resume?
Copiesofcurrentcertifications?
CPRuptodate?
NationallyRegistered?
AppliedtoLCCC?
Registered?
Math0920orequivalent?
English1010orequivalent?
Vaccinationsortiters–
Heb B
TB (<1year)
MMR
Tetanus (<10years)
Varicella
CallCharles Retzat307.778.1149or307.275.2755withquestions
To be eligible for consideration for the 2019 LCCC Paramedic
Training Program, all applications must be postmarked by
November 1st, 2018. Any applications received postmarked
after this date will not be considered.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
PARAMEDIC PROGRAM SELECTION CRITERIA
The Paramedic Program Selection Committee will be the individuals to consider the applications
submitted by prospective students. The following point scale will be utilized. Only completed
applications will be considered. Applications with requirements not met at the time of
selection may be provisionally admitted pending fulfillment of ALL requirements. Applicants
who submit a completed application will be contacted to schedule a date and time to complete
the entrance examination and interview board. Scores from the entrance examination and
interview board will be combined with the score from the application point scale below. All
persons submitting an application will be notified of their admission status following the
selection process.
Item
Points
Currently licensed in Wyoming as an EMT
5
Current NREMT-B certification
20
Current licensure at AEMT level or higher
5
At least 3 years’ experience in EMS or a related field
10
At least 1 year experience in EMS or healthcare
5
Applied to and accepted at LCCC
5
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
2019 Paramedic Program Applicant Checklist
Laramie County Community College is committed to providing a safe and nondiscriminatory educational
and employment environment. The college does not discriminate on the basis of race, color, national
origin, sex, di
sability, religion, age, veteran status, political affiliation, sexual orientation or other status
protected by law. Sexual harassment, including sexual violence, is a form of sex discrimination prohibited
by Title IX of the Education Amendments of 1972. The college does not discriminate on the basis of sex in
its educational, extracurricular, athletic or other programs or in the context of employment.
The college has a designated person to monitor compliance and to answer any questions regarding the
college's nondiscrimination policies. Please contact: Title IX and ADA Coordinator, Suite 205, Clay
Pathfinder Building, 1400 E College Drive, Cheyenne, WY 82007, 307.778.1217,
TitleIX_ADA@lccc.wy.edu.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
WYOMING OEMS SYSTEM FUNCTIONAL POSITION DESCRIPTIONS FOR EMT-PARAMEDIC
EachcandidatemustsuccessfullycompletetheWyomingOceofEMSapproved
TrainingCurriculumandachieveapassingscoreonthepraccalandwrien
cercaonexaminaons.
Thecandidatemustbeatleasteighteen(18)yearsofagewhenapplyingforEMT,
EMT-I(Intermediate),orParamedicCercaon,orwithinsix(6)monthsofthe
conclusionoftheDivisionapprovedEMTTrainingProgram.
Thecandidatemustpossesstheabilitytocommunicateverballyandvia
telephoneandradioequipment.
Thecandidatemustpossesstheabilitytointerpretwrienandoralinstrucons;
mustpossesstheabilitytousegoodjudgmentandremaincalminhighstress
situaons;mustpossesstheabilitytobeunaectedbyloudnoisesandashing
lights;mustpossesstheabilitytofunconecientlythroughouttheenrework
shiwithoutinterrupon.
Thecandidatemustpossesstheabilitytointerviewpaents,familymembersand
bystanders;possesstheabilitytodocument,inwring,allrelevantinformaon
inprescribedformatinlightoflegalramicaonsofsuch;possesstheabilityto
converseinEnglishwithco-workersandhospitalstaastothestatusofpaents.
Thecandidatemustpossessgoodmanualdexteritywiththeabilitytoperform
tasksrelatedtothedeliveryofthehighestqualityofpaentcare;mustpossess
theabilitytobend,stoopandcrawlonuneventerrain;possesstheabilityto
withstandvariedenvironmentalcondionssuchasextremeheat,cold,and
moisture,andpossesstheabilitytoworkinlowlightandconnedspaces.
Laramie County Community College is committed to providing a safe and nondiscriminatory
educational and employment environment. The college does not discriminate on the basis of
race, color, national origin, sex, disability, religion, age, veteran status, political affiliation, sexual
orientation or other status protected by law. Sexual harassment, including sexual violence, is a
form of sex discrimination prohibited by Title IX of the Education Amendments of 1972. The
college does not discriminate on the basis of sex in its educational, extracurricular, athletic or
other programs or in the context of employment.
The college has a designated person to monitor compliance and to answer any questions
regarding the college's nondiscrimination policies. Please contact: Title IX and ADA Coordinator,
Suite 205, Clay Pathfinder Building, 1400 E College Drive, Cheyenne, WY 82007, 307.778.1217,
TitleIX_ADA@lccc.wy.edu.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
COMPETENCY AREAS
EMT-Basic
Thecandidatemustdemonstratecompetencyinassessingapaent,handlingemergenciesulizing
BasicLifeSupport(BLS)equipment.PossesstheabilitytoperformCPR,controlhemorrhage,provide
non-invasivetreatmentforinadequatessueperfusion,splinngandspinalimmobilizaon,useof
semi-automacdebrillator,possesstheabilitytoadministerself-assistedmedicaons,manage
environmentalemergenciesandemergencychildbirth.
EMT-Intermediate
ThecandidatemustdemonstratecompetencyinallEMT-Basicskills.Mustbeableto,ifauthorized;
provideAdvancedLifeSupport(ALS)usingintravenoustherapy,advancedairwaymanagement,
medicaonadministraonanddebrillaonaccordingtoguidelinesestablishedbytheWyomingOce
ofEmergencyMedicalServices.
EMT-Paramedic
ThecandidatemustbecompetentinulizingallEMT-BasicandEMT-Intermediateskillsandequipment
andbeabletoperformunderotherAdvancedLifeSupport(ALS)standardsformedicalandtrauma
emergenciesconsistentwithguidelinesestablishedbytheWyomingOceofEmergencyMedical
ServicesandunderthedireconofaPhysician.
Descripon of Tasks
Receivecallfromdispatcher,respondverballytoemergencycalls,readmaps,maydrivevehicleto
emergencysitesusingmostexpediousroute,andobserveordinancesandregulaons.
Determinethenatureandextentofillnessorinjury,takepulseandbloodpressure,visuallyobserve
changesinskincolor,makedeterminaonregardingpaentstatus,establishpriorityinemergency
care,renderappropriateemergencycare(basedoncompetencylevel),mayadministerintravenous
medicaonsoruidreplacement,ifceredanddirectedbymedicalcontrol.Mayuseequipment
(basedoncompetencylevelandcercaon)suchas,butnotlimitedto,monitorwithdebrillatorand
performendotrachealintubaontoopenairwaysandvenlatepaents.Administermedicaonsas
authorized.
Assistinliing,carryingandtransporngpaentstoambulanceandontothemedicalfacility.
Reassurepaentandbystanders.Avoidunderhasteandmishandlingofpaents.Searchformedical
idencaonemblemtoaidincare,extricatepaentsfromentrapment,assessextendofinjury,use
prescribedtechniquesandappliances,radiodispatcherforaddionalassistanceorserviceandprovide
lightrescueservices.Provideaddionalemergencycarefollowingestablishedprotocols.
Complywithregulaonsinhandlingthedeceased;nofyauthoriesandarrangeforproteconof
propertyandevidenceatscene.Determineappropriatefacilitytowhichpaentwillbetransported,
reportnatureandextendofinjuriesorillnesstothatfacility,andaskfordireconfrommedicalcontrol
oremergencydepartment.Idenfydiagnoscsignsthatrequirecommunicaonwithmedicalfacility.
Assistinremovingpaentfromambulanceandintoemergencyfacility.Reportverballyandinwring,
observaonsaboutandcareofpaentatthesceneandenroutetomedicalfacility.Provideassistance
tomedicalstaasrequired.Replacesupplies,checkallequipmentforfuturereadiness,maintain
emergencyvehicleinoperablecondion,ensurescleanlinessandorderlinessofequipmentand
supplies,anddecontaminatesvehicleinterior.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
APPLICATION INSTRUCTIONS
ThankyouforyourinterestintheLaramieCountyCommunityCollege
ParamedicProgram.
Pleaseensurethatyoulloutthisapplicaoninitsenrety.Failuretodosomay
resultinyourapplicationnotbeingaccepted.
Thefollowingitemsmustbeincluded and returnedwithyourapplication:
CompletedApplication(EnsureyouprovideALLREQUIREDsignatures)
WrittenInterview Questions
• Theinterviewquesonnaireisincludedinthispacket.Youmayuse
theincludedspacestocompleteyouranswers;however,wehighly
recommendthatyoutypetheanswerstoyourquesonsinaseparate
documenttoallowyoutoprovidemoredetail.
CopyofCurrentCPRCard
CopyofCurrentEMT Certification or higher
CopyofCurrentvaccinations
CopyofCurrentACLSCard(If Applicable)
CopyofCurrentPALSCard(If Applicable)
Anyotherobtainedcertifications,
applicable transcripts and other documents
found on the checklist page.
Please remember to apply for admission to Laramie County
Community College in conjunction with the completion of this
application if you are not currently an LCCC student. Applying to
LCCC can be completed at:
http://www.lccc.wy.edu/admissions/index.aspx
Please return the completed application and all required
documents by November 1st, 2018 to:
LaramieCountyCommunityCollege
ParamedicTrainingProgram,TC109
1400E.CollegeDrive
Cheyenne,WY82007
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
APPLICATION
APPLICANT INFORMATION
Name(Last, First, MI):
DateofBirth: SSN: Phone:
DriverLicense#: DriverLicenseState:
Male   Female
CurrentAddress:
City: State: ZIPCode:
PREVIOUS TRAINING
EMTBasicClassLocaon:
DateofCompleon: NREMT#andExpiraon(If Cered):
EMT-A or EMT-IClassLocation(If Applicable):
DateofCompleon: NREMT#andExpiraon(If Cered):
ModulesCompleted:
AreyoucurrentlyWyomingStateCered?
Yes   No
State#:
AFFILIATION
AreyoucurrentlyaliatedwithanEMSAgency? Yes   No
NameofService:
Address:
City: State: ZIPCode:
NameofSupervisor: Phone:
CRIMES AGAINST A PERSON, FELONY STATEMENT AND LICENSING ACTION
Haveyoueverbeenconvictedofacrimeagainstaperson? Yes   No
Haveyoueverbeenconvictedofafelony? Yes   No
Haveyoueverbeensubjectedtolimitaon,suspensionorterminaonofyourrighttopracceinahealthcareoccupaon
orvoluntarilysurrenderedahealthcarelicenseinanystateortoanagencyauthorizingthelegalrighttowork?
Yes   No
If you answered “yes” to any of the quesons above, please provide details below.
You must also provide ocial documentaon of the current status and disposion of the case.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
APPLICATION (continued)
CERTIFICATION OF ELIGIBILITY (SIGN ONLY ONE)
Eachstudentand/orcandidateforWyomingOceofEmergencyMedicalServicescercaonmustsignone
(1) ofthetwo(2)followingstatements.
Bycheckingthisboxandsubmingthisapplicaon,IherebycerfythatIhavereadandunderstandthe
FunconalJobDescriponofanEMT(Includedinthispacket).Ihavenocondionswhichprecludeme
fromsafelyandeecvelyperformingallthefunconsofthelevelofEMTforwhichIamseekingtraining
andastateofWyomingEMSCercaon.
NameofCandidate(Please Print):
Signature: Date:
Bycheckingthisboxandsubmingthisapplicaon,IherebycerfythatIhavereadandunderstand
thefunconalJobDescriponofanEMT.Iwillbesubmingarequestforanaccommodaon(s)forthe
WyomingOEMSadministeredCercaonExaminaon(s).IunderstandthatifIamenrolledinatraining
course,ImustcontacttheWyomingOEMSnolaterthansix(6)weekspriortotheWyomingOEMS
administeredWrienCercaonExaminaonforthispurpose.IfIhavealreadycompletedtraining,my
wrienrequestforaccommodaon(s)mustaccompanythisapplicaon.
NameofCandidate(Please Print):
Signature: Date:
STATEMENTS / AUTHORIZATION
Bycheckingthisboxandsubmingthisapplicaon,Iherebycerfythatallstatementsmadeonthis
applicaonaretrueandcorrect.Falsestatementsmayresultinremovalfromtheprogramordenialof
authorizaontotaketheNaonalRegistryofEmergencyMedicalTechnicianswrienexaminaon.
IauthorizetheWyomingOceofEMStocontactsuchagenciesasmaybenecessarytoverifythis
informaon.ThisshallalsoserveasareleaseforsaidagenciestoprovideinformaontotheWyoming
OceofEmergencyMedicalServices.
NameofCandidate(Please Print):
Signature: Date:
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
APPLICATION (continued)
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
1) Inyourcurrentlevelofcercaon,canyougiveoneexampleofhowyourenhancedapaent’s
service/paentrelaons?
2) Whatreasons/ExperiencesaractedyoutoacareerinEMS/Pre-hospitalmedicine?
3) Howwouldyourankthevalueofpursuingconnuingeducaon(onascaleof1-10)?Why?
4) WhatdoyouperceivearetheprimaryduesofbeingaParamedic?
5) WhatthreecharacteriscsdoyouhavethatwillenableyoutobeasuccessfulParamedic?
Explainwhyyouchoseeachcharacterisc?
6) HowdidyoundoutabouttheParamedicProgramatLCCC?
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
7) IfacceptedintotheParamedicprogram,whatprofessionalgoalswouldyouliketoachieveinthenext
veyears?
8) Howdoyoudealwithconict(co-workers,physicians,instructors,fellowstudents)?
9) Whatmovatesyoutoputforthyourgreatesteort?
10) Thinkofasituaonwhereyouhadtointeractwithadicultperson(asapeer,customer,employee,
etc.).Describethecircumstancesofthesituaonandhowyoudealtwiththepersonandsituaonin
ordertoresolvetheconict.
11) Thisprogramisintense,butintheendveryrewarding.Somecommentsfrompastgraduatesare:
“study,study,study...”;“Bereadytogiveupalotofme...”;“stayfocusedanddon’tgiveup....”
Obviously,thisprogramrequiresagreatdealofstudyandclinicalme.Whattypesofsupportdoyou
feelthatyouwillhavefromfamilyandfriends?
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
APPLICATION (continued)
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
12) AsaParamedic,doyoufeelyouwouldbeabletotakecontrolofascene,evenwhenseniorocersor
otherParamedicsarepresent?Why?
13) Thinkofasituaonwhereyouhadmulpletaskstocompletewithsimilardeadlines.Describethe
aconsyoutook/willtaketoensurethemelycompleonofthetasks.
14) Describeyourroleasapaentadvocate.
15) Whyshouldweacceptyouintotheprogramoversomeoneelse?
16) Whatwouldyoudoifapsychocpaentbecameaggressivetowardyou?
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
APPLICATION (continued)
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
17) Pleasedescribeindetailhowyouwouldhandlethesituationoutlinedbelow;
• Youarriveforyourshiftandfindyourpartnersleepingonthecouchinthestation.Youproceedwith
yourunitcheck-offandintheprocessreceiveadispatchtoacardiacarrest.Yourpartnercomesto
theambulanceandsmellsstronglyofETOH.Theyreplythatthesmellistheirnewcolognewhen
asked.Describehowyouwouldhandlethissituation.
Quesons/Comments?
NameofCandidate(Please Print):
Signature: Date:
EVEN IF YOU COMPLETE THIS WRITTEN APPLICATION IN ANOTHER DOCUMENT, YOU MUST STILL SIGN.
PLEASE READ THE INSTRUCTION SECTION OF THIS APPLICATION PACKET
BEFORE SUBMITTING IT TO MAKE SURE YOU HAVE INCLUDED ALL REQUIRED DOCUMENTS.
or andmailto:Charles Retz
LaramieCountyCommunityCollege
1400E.CollegeDrive, TC 109
Cheyenne,WY82007
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES
APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
APPLICATION (continued)
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
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click “EMAIL.”
1. The window will ask you to select your email client.
2. If you use Microsoft Outlook Express, Microsoft
Outlook, Eudora or Mail, click “OK” in the pop-up
window. The form will be emailed to us. Please be
sure that the email address is CRetz@lccc.wy.edu.
3. If you use any other client, such as Yahoo or Hotmail,
choose “Internet Email,” then click “OK.”
• Thecomputerwillsavetheformtoyourharddrive.
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attach the form to a message and email it to
cretz@lccc.wy.edu.
4. Please contact Charles Retz at 307.778.1149 to make
suretheformwasreceivedsuccessfully.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
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Paramedic Application 2019 LCCC Paramedic Program Application 2019

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Completed 14 February 2020

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