Do you possess one year paid work experience performing cardiac diagnostics procedures including echocardiograms?
Yes
No
If you answered yes to question #1, identify the following:
Name of employer(s)
Position title(s) you possessed
Employment timeline(s)
Average hours worked per week
Duties performed
2.
Have you completed an approved training course in echogradiography technology or ultrasound technology?
Yes
No
If you answered yes to question #2, identify the following:
Name of educational institution
Name of training course/program
Date of completion/graduation
3.
Are you currently certified as a Registered Diagnostic Cardiac Sonographer?
Yes
No
If you answered yes to question #3, identify the following:
Type of certification
Certification number
Date of issuance
Expiration date
4.
Are you currently certified as a Registered Cardiac Vascular Technician (RVT)?
Yes
No
If you answered yes to question # 4, identify the following:
Type of Certification
Certifcation number
Date of issuance
Expriation date
5.
Are you currently certified as a Registered Diagnostic Medical Sonographer (RMDS) in good standing with the American Registry of Diagnostic Medical Sonography (ARDMS)?
Yes
No
If you answered yes to questions 5, identify the following: