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* 1. Applicant Information

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* 2. Email Contact

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* 3. What class are you applying for?

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* 4. Emergency Contact Information

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* 5. Are you currently a Transformative Healthcare employee?

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* 6. How long have you worked at either Fallon or Lifeline Ambulance Service?

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* 7. Do you currently have full-time status with either Fallon or Lifeline Ambulance?

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* 8. What is your current level of EMS Certification?

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* 9. Has your certification or authorization to practice ever been revoked or suspended?

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* 10. Have you ever falsified training records or requirements related to EMS Certification?

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* 11. EMT Certification Information

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* 12. How long have you been an EMT?

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* 13. Advanced Education

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* 14. Please use the space below to answer the following question:
Why would you be a great candidate for our Paramedic Program?

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* 15. What would be your largest challenge in completing a Paramedic Program?

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* 16. Please indicate YES to the following statements as confirmation of understanding.

  Yes No
I understand that this program requires me to be subject to criminal and / or background checks, the results of which may affect my admission and / or continued participation in this program.
I understand that this program prepares me for licensing and / or credentialing as paramedic, but it neither licenses or certifies me as a paramedic.
I understand that NREMT certification exam fees are not included in my tuition.

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* 17. Thank you.  You will receive an email shortly to schedule an entrance interview via Zoom.

When preparing for your interview, please be prepared to submit copies of your certifications and a copy of your drivers license.

First Response EME does not discriminate on the basis of race, creed, color, sex, age, nationality, or sexual orientation.

I attest that all of the information provided by me is true and correct to the best of my knowledge. Any attempt to offer incorrect or fraudulent information will result in immediate withdrawal of this application, termination from the program, and forfeiture of future program acceptance.

 
100% of survey complete.

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