Instructor ApplicationPlease enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *I understand that I will be employed as an independent contractor with Pet Emergency Education and compensated $20 per person in the classes I teach. I understand that I AM NOT allowed to go teach classes on my own and that the company manages all of the classes and financial aspects directly. *I agree*See instructor contract for complete program requirements.Provide a brief description of why you would like to be a pet CPR instructor *Welcome and orientation phone calls are conducted for new instructors Monday through Friday sometime between 10am-5pm PST . If you are not available during this time please list the best time you are available.Please list your emergency work and/or teaching experience *If you are interested in teaching other classes with us, check off which onesEquiAid Emergency First Aid for HorsesPetCPR+ Advanced for Vet Professionals (vets and vet techs only)Wilderness First Aid for DogsI understand that I am required to purchase an instructor kit which contains all of my animal models and teaching supplies. The cost for this kit $450 and must be purchased at the end of the training.I AgreeHow did you hear about us? *Choose OneFacebookJob BoardIndeedRecruiter (Matt)Recruiter (Theresa)Recruiter (Nicole)EmailFaxReferral from current instructor (list name below)If referral please list name of person referring youI verify that I have read the Instructor CONTRACT AGREEMENT, Policies and Guidelines and agree to abide by all of the rules and requirements stated in it as long as I am an active instructor with Pet Emergency Education. I understand that by filling out this form I am not guaranteed to become an instructor. *I AgreePhoneSubmit 2018-11-13