Pipkin Trainer Application Step 1 of 3 33% Your Personal InformationYour Name(Required) First Middle Last Your Email Address(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your Phone(Required)Best Time To Call You(Required)When is the best time for us to reach you via telephone?Best Time To Call YouMorningsEarly AfternoonLate AfternoonEarly Evening Are you eligible to work in the United States?(Required) Yes No Are you over the age of 18?(Required) Yes No Have you ever been convicted of any crime involving physical violence or sex-related offenses?(Required) Yes No If yes, please explain:(Required)Have you ever been convicted of a felony in the last 5 years?(Required) Yes No If yes, please explain:(Required)Are you First Aid Certified?(Required) Yes No How long have you been a fitness trainer?(Required) Are you CPR/AED Certified?(Required) Yes No Do you carry trainer insurance?(Required) Yes No What Fitness Certifications do you currently hold?(Required) ACE NSCA NASM Other Not Currently Certified Select AllPlease List Other Certifications:(Required) If you are not currently certified, are you willing to get certified?(Required) Yes No What was your college major? Where do you currently train? What is your experience working with seniors? If you were walking with a 200# person and they started to loose their balance, are you confident that you could keep them from fallling?(Required) Yes No If a management position were to become available, would you be interested in more information?(Required) Yes No Do you have access to reliable transportation?(Required) Yes No More About YouTell Us About YourselfHours You Are Available for WorkPlease tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFriday Add RemoveDate you are able to begin work?(Required) Upload Your Resume (not required)Upload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 100 MB.Signature(Required)
