Application Forms - Americanhealth

Application Form for the Assessment of Equivalency to U.S Emergency Medical Services

Click To Download American Health Guide

Select Level *

Name (as per birth certificate or deed poll) *

First

Last

Date Of Birth

Nationality

Gender

Email *

Permanent Address

Address Line 1

Address Line 2

City

State

Zip Code

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Native Language

What is your Highest Level of Education Completed? *

What is your Level of Qualification Completed? *

RECOGNITION OF QUALIFICATIONS - Where is Current Certification Received From

Name of Competent Authority or Regulatory Body

Your Professional Title

Registration Number

Address Of the Competent Authority or Regulatory Body

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Website / URL

Educational Qualifications

Name of Educational Institution

Title of Qualification

Course Start Date

Course End Date

Address Of the Educational Institution

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Website / URL

Name of Educational Institution

Title of Qualification

Course Start Date

Course End Date

Address Of the Educational Institution

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Website / URL

Talents and Awards

List each, a description, the level, and number of years of involvement.

Your Work Experience

Name of the Employer

Current Position

Contact Name

Duration Of Post

Date Of Commencement (copy)

Date Of Cessation

Registration Number

Address Of the Employer

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Website / URL

Your Work Experience

Name of the Employer

Previous Position

Contact Name

Duration Of Post

Date Of Commencement

Date Of Cessation

Registration Number

Address Of the Employer

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Website / URL

Attach an additional Word, PDF or text document if necessary

Click or drag a file to this area to upload.

Please attach a photo of yourRegistration card

Click or drag a file to this area to upload.

Agreement

Assessment of Qualification I hereby declare and note that: 1. All the above information is true and accurate to the best of my knowledge and belief; 2. I hereby consent and give authority to AH to make any inquiry or inquiries with anybody or person in pursuance of my application for assessment of equivalence of professional qualification in pre-hospital emergency care. 3. Data Protection: By signing this form I consent to AH holding and processing my personal data for the purpose of assessing my professional qualifications. AH may also use the data I provide for communication purposes with me. I hereby give permission for American Health and its agents to share my results with Dubai Corporation for ambulance services and to use my analyzed data for research publically.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

Application Form for the Assessment of Equivalency to U.S Emergency Medical Services

Click To Download American Health Guide

RECOGNITION OF QUALIFICATIONS - Where is Current Certification Received From

Educational Qualifications

Your Work Experience

Your Work Experience

Agreement

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