Life Support Certifications

Please complete the following information on life support certifications you currently have.

After completing your Post Offer Assessment at Employee Health, please bring supporting documentation, certificates, or cards for proof of certification for these or any other certifications you hold to your appointment at Human Resources.

Name:

Position/Title:

Your Certifications          Date of Training:
          Date of Training:
          Date of Training:
          Date of Training:
          Date of Training:

Please list any additional information or certifications here: