Train the Trainer Application

Please fill out the form below to apply for the GreenPlumbers Train the Trainer series. All inquiries related to Train the Trainer should be directed to National Training Director, Susan Wayland at: susan@greenplumbersusa.com or via toll-free (888) 929-6207.

General Information

Name: *

Address: *

City: *

State: *

Zip Code: *

E-mail: *

Phone:

Your Affiliation Status: *

Which company or association are you affiliated with, and would be working with to teach the GreenPlumbers curriculum?

If other, please describe:

Please describe your affiliation status if you chose "Other"

Education History

Degree:

Major:

Institution:

If no degree, please list highest education level completed:

Other certificates, notable experiences, or accomplishments that demonstrate expertise on subject matter : *

Plumbing industry experience: *

Previous experience as a trainer: *

Employment History

Current Employer: *

Supervisor/Manager Name: *

Employer Contact Number: *

Job Description: *

Time in Job

From:

To:

Previous Employer

Previous Employer:

Supervisor/Manager Name:

Employer Contact Number:

Job Description:

Time in Job

From:

To:

Please list 2-3 business references we may contact

Name: *

Relationship: *

Daytime Phone: *

(XXX) XXX-XXXX

E-mail Address:

Second Reference

Name (2):

Relationship (2):

Daytime Phone (2):

(XXX) XXX-XXXX

E-mail Address (2):

Third Reference

Name (3):

Relationship (3):

Daytime Phone (3):

(XXX) XXX-XXXX

E-mail Address (3):

Why are you interested in becoming a GreenPlumbers instructor?: *