STEP 1 - Trainer Application
Please take the time to complete the trainer application below.
* Full Name:
* Required Fields
PERSONAL INFORMATION
* Mailing Address:
* City:
* State:
* Zip:
* Direct Phone:
FAX:
* Email:
Website:
AVAILABILITY
* Weekdays:
* Weekends:
* Times:
GEOGRAPHICAL PREFERENCES
Residing Address:
*Same as mailing?
City:
State:
Zip:
* Local travel only?
* Willing to travel nationally?
TOPICS OF EXPERTISE
* Please type in ALL training topics that you are qualified to teach below:
* Qualified to conduct policy/program development?
PERSONAL/PROFESSIONAL REFERENCES
* 1.
* Phone:
* 2.
* Phone:
* 3.
* Phone:
COMMENTS
Tell us more about yourself:
* What language(s) are you fluent in?
(#1 being your primary)
1.
2.
3.
Agreed upon training rates:
- Half day (4) four hours $250.00
- Full day (8) eight hours $500.00
- $25.00 per hour for CPR/First Aid
- 2-Hour classes qualify for half day
Agreed upon consulting rates:
- Hourly $85.00 (CSP, CIH, ASP only)
- Hourly $65.00 (Non-Certified Safety Professional)
other:
Polo shirt size:
(You will be required to wear an ehs polo shirt when training for us)
