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Steps 2 Success Medical Training: Screening Questionnaire 

Thank you for your interest in the Steps 2 Success Medical Training Program, an initiative funded by Kids Hope Alliance and delivered in partnership with NyWes Healthcare Association.

 

You are invited to complete the screening questionnaire below. To be considered for this program, please complete the form by Friday, June 21st.

 

Due to the overwhelming response, we have temporarily halted acceptance of new interest forms as of Friday, June 13th.

 

The questionnaire will help us identify the candidates best suited for this program. Those who advance to the next stage will receive more information on the next steps in the application process.

 

After submitting your questionnaire, please wait a few minutes for your email confirmation. If you do not see the confirmation email, check your spam or junk folder.

 

We look forward to reviewing your application!

Select your age range
18-24
25-54
55-65
65+
Are you a resident of Duval County?
Yes
No
Do you have proof of earning a high school diploma or GED equivalent?
Yes
No
Which course is your first choice?
Medical Assistant (12 weeks)
Phlebotomy Tech (8 weeks)
If you did not get accepted into your first choice, would you be open to participating in your second choice if offered a spot?
Yes
No
Are you able to commit to attending all evening classes (twice a week)?
Yes
No

Screening Requirements

Background Screening Requirements: Generally, providers of care in the state of Florida, who interact directly with patients, are subject to healthcare background check requirements. A medical assistant/phlebotomist technician healthcare Level 2 background check is a comprehensive evaluation conducted by employers during the hiring process. Level 2 background screening includes fingerprinting for statewide criminal history records checks through the Department of Law Enforcement (FDLE) and national criminal history records checks through the Federal Bureau of Investigation (FBI).

TB Skin Test Requirement: It is required to have an updated TB (Tuberculosis) skin test for these healthcare professions, as you will be working directly with patients. If you need an updated test, NyWes Healthcare Association offers this service for a nominal fee of $5.

Are you willing to take the TB skin test as part of the program requirements?
Yes
No

Work Authorization Requirement: Florida Statutes require that employer(s) verify a new employee’s employment eligibility; this is done using an I-9 issued by the U.S. Citizenship and Immigration Services, or the E-Verify system. Our program has a workforce placement component, you would be required to provide proof of employment eligibility to a future employer.

Are you authorized to work in the United States?
Yes
No

Career Goals & Motivation

Are you able to provide the contact information for two references who can speak to your character, work ethic, and suitability for the program?
Yes
No
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