OCEMT FD Applicants

Question Title

* 1. Personal Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Date of Birth

Date / Time

Date

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* 3. I have a current driver's license which is required to register

Yes

No

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* 4. I have a high school diploma or a GED

Yes, I meet or will meet the above requirement

Question Title

* 5. I have completed an EMT basic course and hold a current EMT card

Yes, I meet or will meet the above requirement

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* 6. I hold a CPR card from the American Heart Association "Healthcare Provider Level"

Yes, I meet or will meet the above requirement

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* 7. I have a minimum of 1000 hours of part-time or full-time experience as an EMT prior to the application deadline.

Yes, I meet or will meet the above requirement

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* 8. Employment Information

Business Name or Company Name

Contact Name

Contact Phone

Contact Email

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* 9. Have you attended another Paramedic Program

Yes

No