AEMT online application AEMT online application Personal Information Name * Name First First Last Last Date * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone * Email * Do you currently have a valid driver's license? * Yes No Have you ever been convicted of a felony? * Yes No Have you ever obtained a state licensure in this state or any other that was revoked for disciplinary reasons? * Yes No Do you currently work for a government agency in Sumner County (or any surrounding counties) such as a Fire or Police/Sheriff's Departments? * Yes No Please elaborate: * Have you previously gone to EMT, AEMT, or Paramedic school? * Yes No Where and when? * Educational Background High School or GED? * High School GED If High School, name of School * Year graduated: * College Hours completed Degree Year graduated Other education/training (describe) Work Experience Describe your work experiences, particularly any experience you may have in pre-hospital care, public safety, or health care Interests Give a brief description on why you are interested in becoming an AEMT How did you learn about our program? Are you thinking about or pursuing employment at Sumner County EMS? Yes No I verify that all information is, to the best of my knowledge, accurate. I also acknowledge that a criminal record check will be required in the future before performing patient care in the hospital setting. * If you are human, leave this field blank. Submit Δ
