Sumner County EMS EMTB Online Application

Sumner County EMS

EMTB Online Application

AEMT online application

Personal Information

Name *

Name

First

Last

Date *

Address *

Address

City

State/Province

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Have you ever obtained a state licensure in this state or any other that was revoked for disciplinary reasons?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. *

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