The applicant's final transcript and/or certificate must be provided. You can upload it in this section or fax it to us at 888.390.7727.

All approved phlebotomy experience credited toward certification must be earned in an approved healthcare facility such as a hospital, physician office laboratory, independent laboratory, HMO, group practice, etc.

If you are not teaching a course at this time you can leave this section blank. Simply scrool down to the end of the page and click next.

In color 2 x 2 inches (Square) in size Sized such that the head is between 1 inch and 1 3/8 inches (between 25 and 35 mm) from the bottom of the chin to the top of the head. View the Photo Composition Template for more size requirement details. Taken within the last 6 months to reflect your current appearance Taken in front of a plain white or off-white background Taken in full-face view directly facing the camera With a neutral facial expression and both eyes open Taken in clothing that you normally wear on a daily basis: Uniforms should not be worn in your photo, except religious clothing that is worn daily. Do not wear a hat or head covering that obscures the hair or hairline, unless worn daily for a religious purpose. Your full face must be visible, and the head covering must not cast any shadows on your face. Headphones, wireless hands-free devices or similar items are not acceptable in your photo. If you normally wear prescription glasses, a hearing device or similar articles, they may be worn for your photo. Dark glasses or nonprescription glasses with tinted lenses are not acceptable unless you need them for medical reasons (a medical certificate may be required) Glare on glasses is not acceptable in your photo. Glare can be avoided with a slight downward tilt of the glasses or by removing the glasses or by turning off the camera flash.

I hereby give my authorization to the PhlebotomyInstructor.com an Allied Health Education Corp Company for Healthcare Professionals to request necessary information from individuals, institutions, and/or organizations named herein to validate information for certification. I certify that the information given herein is true and correct, to my knowledge and belief, and realize that certification is subject to revocation for misrepresentation. If accepted as a phlebotomy instructor, I agree to uphold and abide by the Standards of Practice and Bylaws of the PhlebotomyInstructor.com. I hereby authorize PhlebotomyInstructor.com to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that PhlebotomyInstructor.com will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice.I hereby consent to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis, as shall be determined PhlebotomyInstructor.com in order to meet with their policy regarding the selection of applicants for employment. I further authorize and give full permission to have the PhlebotomyInstructor.com and/or its authorized agents and physicians to send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the PhlebotomyInstructor.com. I further agree to and hereby authorize the release of the results of said tests to the PhlebotomyInstructor.com. I understand that it is the current use of illegal drugs that would prohibit me from being employed at PhlebotomyInstructor.com and receiving certification. I further agree to hold harmless PhlebotomyInstructor.com and its agents and physicians from any liability arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with the PhlebotomyInstructor.com consideration of my application of employment. DISCLAIMER The syllabus and material does not establish a contractual relationship between Allied Health Education Corp and/or any phlebotomy instructor-student. Rather the syllabus is provided to define a broad outline of the course structure and goals. The phlebotomy instructor reserves the right to modify, change or otherwise alter the details of instruction and material coverage offered in any class in response to class progress and interests. Please remember that existing artwork, images, and text that you may want to include in your projects may be protected under copyright law. The unauthorized incorporation of such material into your new work could be a violation of the rights of the copyright owner. Please be sure to obtain all permissions required from the copyright owners. No part of this web site may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, recording, or otherwise, without the prior written permission of the instructor. The material on this website is reserved solely for use by the instructor, and only those students, while enrolled in the specific courses listed. This web site, as well as the software described in it, is furnished for informational and instructional use only, is subject to change without notice, and should not be construed as a commitment by the instructor. The material presented at this site will contain examples of both good and bad practices and is presented “as is” for instructional purposes. The instructor assumes all responsibility or liability for any errors or inaccuracies in the material that may appear in this web site. Allied Health Education Corp solely provides the materials and curriculum to teach a phlebotomy course. The instructor assumes all liability of teaching the phlebotomy course and is solely responsible for knowing and understanding state regulatory requirements that may pertain to their certification and/or ability to practice in their profession in their particular state. The instructor expressly disclaims all implied, express, or statutory warranties, without limitation, the implied warranties of merchantability, non-infringement of third party rights and fitness for a particular purpose. The instructor will be liable for damages, whether direct, indirect, special, incidental, or consequential, as a result of the reproduction, modification, distribution, or other use of the material, onsite education, classroom scheduling, payments, and clinical performed during class. These Terms and Conditions shall be governed by and construed in accordance with the laws of the State of Florida. You hereby consent to binding arbitration in the State of Florida to resolve any disputes arising under this Terms and Conditions.