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Home My WebLink About206654 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 365721 Page 1 of 1 ONE CIVIC SQUARE MIKE DELONG CARMEL, INDIANA 46032 cio cFO CHECK AMOUNT: $140.00 st CHECK NUMBER: 206654 CHECK DATE: 2/28/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4350900 140.00 OTHER CONT SERVICES Order Confirmation Page 1 of 1. Order Confirmation Date of Order: February 15, 2012 School Name: St. Vincent Hospital EMS Education Personal Information: Name: Michael Thomas DeLong DOB: 11/28/1975 Order Number: 9012 0215 1745 -3600 Package S135: County Criminal Hamilton, IN Michael Thomas DeLong Nationwide Sexual Offender Index Michael Thomas DeLong Nationwide Healthcare Fraud And Abuse Scan Certified Drug Test Michael Thomas DeLong Nationwide Patriot Act Michael Thomas DeLong Social Security Alert Michael Thomas DeLong Residency History Michael Thomas DeLong Medical Document Manager Annual CRR Total Price: $125.00 Additional Information: The package price above includes a search of your current county of residence. If any additional counties are found associated with your name they will be performed at no additional charge. Notice: This package includes document storage. At the end of the background check order process, you will be prompted to upload specific documents required by your school for immunization, medical or certification records. Important Drug Test Information: Your drug testing form will be available to you within 24 business hours. You will either receive an email from CertifiedProfile.com with your registration form attached or you will have receive a notification to return to your Certified Profile account and read the instructions within your Drug Test To -Do List. Please contact our Student Services Department with any questions regarding your order at: (888) 914 -7279 or studentservices @certifiedprofile.com. https /www.certifiedprofile.com /online_ submission /print_confirmation.php 2/15/2012 -?NC Online Banking Page of "1. My Accounts Transfer Funds Pay Bills Alerts Customer Service Summary Account Activity Account Activity Jamie Available Balance: $ Account Activity Online Statements Pending Transactions Date Description Withdrawals Deposits Av 02/21/2012 VISA BRITTON TAVERN $18.00 Lei 02/21/2012 VISA RIVIERA MAYA MEXIC $25.36 Pe Pe 02/21/2012 VISA- ROMANOS MACARONI GRIL $23.44 02/21/2012 VISA PUBLIC SAFETY HEALTH $15.00 La: 02/21/2012 VISA PUBLIC SAFETY HEALTH $0.25 La: 02/21/2012 VISA LIV *LIVINGSOCIAL $15.00 02/20/2012 VISA BUFFALO WILD WINGS FI $31.05 AC Ni( Posted Transactions TYI Te: Ni( List by Date List by Type Search Filter: All Export Ad View All 1 2 3 4 i 5 6 next Ac Date Description Withdrawals Deposits Balance https: /www.onlinebanking.pnc.com/ alservlet /DepositActivityServlet ?account= //////////350... 2/22/2012 -PNC Online Banking Page 2 of 3 j Date Description Withdrawals Deposits Balance 02/17/2012 CHECK CARD PURCHASE $125.00 $2,015.88 XXXXX2284 CERTIFIEDBACKGROUNDCO XXXXX388 https:// www. onlinebanking. pnc. com/ alserviet /DepositActivityServiet ?account= //////////350... 2/22/2012 PJNC Online Banking Page 3 of 3 Date Description Withdrawals Deposits Balance 5 6 next 2 3 4 View All 51� Inl[GiactiveDorno f Online Banking &Bil[ Pay Guarantee I Service Agreement Privacy Policy f;;% Copyright 2012. lhe PING Financial Services Group, Inc. All Rights Reserved Version: 34,00,01 Need Help? Call us at 1 -888-PINC-BANK (762-2265) 1--icurs htips://www.onlinebanking.pnc.com/alservief/DepositActivityServiet?account=/// 2/22/20-12 ad I St. Vincent EMS Education and 'Training Center Paramedic Program PREREQUISITES Applicants for Paramedic Education: I. MUST be a least eighteen (18) years of age. A photocopy of the individual's birth certificate must accompany the application. 2. MUST be a graduate of a standard four -year high school program (GED accepted). High school OR college (if applicable) transcripts must be submitted to the program director following applicant request to school. The program director will not request transcripts. 3. MUST hold a valid certificate as an Emergency Medical Technician issued by the Indiana Department of I- lomeland Security or NREMT. A copy of DI-IS certifications must be returned with the application and can be found at littn:Hww%v. in.jzov /dhs /2383.litm 4. MUST hold a current Healthcare Provider CPR card issued by the American Heart Association (Indiana Affiliate), and no more than six (6) months preceding the paramedic course initiation date. A photocopy of the card must be included with the individual's application. 5. MUST document a minimum of twenty (20) hours of ambulance patient compartment staffing time when transporting an emergency patient(s) during the year preceding the course initiation date. This documentation must be verified by the signature of the chief executive officer of the ambulance service. 6. MUST be recommended as a candidate for paramedic education by an Indiana licensed physician. 7. MUST be able to give and receive verbal and written instructions and directions reliably, and demonstrate maturity of judgment, good moral character, motivation, and dependability. 8. MUST submit three (3) references. Forms are provided in this packet for this purpose. Close friends and relatives cannot be utilized for this purpose. References MUST be provided from each of the following categories: Someone familiar with the applicant's EMT skills and experience A person knowledgeable orthe applicant's character, abilities and desire to become an EMT -P Present or past employer of the applicant All reference letters MUST be signed and dated no more than 90 days before the beginning of class, and sent directly to the Paramedic Program Director BY THE REFERENCE, not the applicant. 9. MUST submit a formal letter of introduction. 10. MUST complete a standardized aptitude examination. This examination will test general aptitude in verbal, arithmetic, reading comprehension, and natural sciences that is above or commensurate with paramedic providers nationally 11. MUST demonstrate EMT knowledge and skills proficiency at a level deemed appropriate by the Education Program by successfully completing entry examinations which include written and practical sessions. 12. MUST submit to a personal interview by a selection committee, with respect to mental and physical qualifications, educational attainment, and aptitude to become an EMT -P. Once accepted into the program, applicants: I. MUST set up an account with Certified Background, which provides the following services for St. Vincent EMS Education: background check, Immunization Tracker documentation management and drug screen testing. All three services are mandatory for enrolling students, a requirement of the program AND the institution. The cost for these services is approximately $120, and the financial obligation of the applicant. Access paperwork will be sent to the applicant once the position has been accepted. PUBLIC SAFETY HEALTH SE.R 11530 ALLTSONVILLE ROAD FISHERS, IN. 46033 317 -972 -1180 Sale ID: 0075420008013879716000 0221. 10:3256 Fppr Code, 2222:3 Invoico: 9009!22 total, $15,00 DU5t0lter DOPY THANK YOU! Snyder, Denise W From: Hulett, Mark A Sent: Thursday, February 23, 2012 2:45 PM To: Snyder, Denise W Subject: RE: Yes they had to have documentation that they received the Hepatitis B series before they can have patient contact. From: Snyder, Denise W Sent: Thursday, February 23, 2012 2:44 PM To: Hulett, Mark A Subject: RE: Was this required for the medic class? From: Hulett, Mark A Sent: Thursday, February 23, 2012 2:37 PM To: Snyder, Denise W Subject: Importance: High Denise The $15.00 fee was for any Paramedic Student that requested a copy of their medical records from Public Safety Medical. Mark Mark A. Hulett FF/EMT-P, P.I. EMS Division Chief AHA CTC'Coordinator City of Carmel Fire Department 2 Civic Square Carmel, Indiana. 46032 Office: 317-571-2663 Cell: 317-428-8784 Fax: 317-571-2693 rnhuleft(ZD_carmel.in._qov IF P 4 M-A D cl, r V, V VOUCHER NO. WARRANT N ALLOWED 20 Mike Delong IN SUM OF $140.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE I AMOUNT Board Members 1120 I I 43- 509.00 I $140.00 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except FEB 2 4 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Background Check Immunization Records $140.00 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 ,20 Clerk- Treasurer