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Have you ever obtained a state licensure in this state or any other that was revoked for disciplinary reasons?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