[City of Virginia Beach] Application for ALS Internship

Application for ALS Internship

Note: This application is for certified Virginia EMS providers seeking ALS release to general supervision.

Application Information

Date

Phone Number

Applicant Email

Supervisor Email

VA State Certification AEMT/ I / P

Released Certification with VBEMS EMT / A / I

Officer Code:

Rescue Squad /DEMS/VBFD Station

Certifications, Documents, and Identification – Submit current copies of all the following: (enter date of expiration if no expiration date, enter date of initial certification)

Certification/Provide Date

Virginia AEMT

Virginia Intermediate

Virginia Paramedic

NREMT - AEMT

NREMT - Paramedic

TEMS Test Passed (If applicable)

TEMS Sanctioned Certificate (If applicable)

CPR

ACLS

PALS/PEPP

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Uniforms - For Department of EMS members only

T-Shirt Size *

Sweatshirt Size *

Disclaimer and Signature

To applicant’s immediate supervisor, The applicant must have this application signed by their immediate supervisor that may include the following: VB Rescue Squad Commander, Assistant Squad Commander, VBEMS Captain, VBFD Captain, or VBFD EMS liaison.

By signing below verifies that the applicant is a member in good standing and approves the applicant for consideration for an ALS Field Clinicals with the City of Virginia Beach Department of EMS.

Supervisor Sign Here

First Name

Last Name

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By signing below verifies that the applicant is a member in good standing and approves the applicant for consideration for an ALS Field Clinicals with the City of Virginia Beach Department of EMS.

Applicant Agreement

With submission of this application, I understand that, at time of application and continuing until all contract obligations are met, I must:

Adhere to Virginia Beach Department of EMS policies. Applicants have reviewed the ALS Training Policy, and the Certification and Credentialing Policy. Located at Lexipol or Vector Solutions.
Virginia Beach Fire Department Employees
- Approved ALS Interns will need to get approval from their direct supervisor and/or the VBFD EMS liaison for schedule adjustments and any overtimed worked.
- A minimum of 3 pre-scheduled ALS precepting shifts per month with EMS, assigned by the ALS Coordinator.
Virginia Beach EMS Volunteers
- Approved ALS Interns shall be granted a temporary reduction in monthly station duty hour requirements to 0 hours per month. The maximum period for this reduction is 2 months for AEMT and up to 3 months for paramedic.
- A minimum of 3 pre-scheduled ALS precepting shifts per month assigned by the ALS Coordinator.
Have/maintain current EMS certification recognized by the Commonwealth of Virginia Office of EMS. (AEMT Only)
Complete Daily Observation Report (DOR) within Field Training and Evaluation Program (FTEP) before leaving shift.
Have no outstanding Vector assignment or expired Vector credentials.
Have documented completion of required Virginia Beach Department of EMS training.
Remain in compliance with any current contracts with Virginia Beach Department of EMS.