Deployment Application
This application is to be used ONLY for those wishing to become credentialed with EMS Team LLC to do deployments through Emergency Management Agencies.
Full Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone:
*
-
Area Code
Phone Number
E-mail:
*
Areas Of Interest:
*
EMT / AEMT
Paramedic
EMS Driver (no certification)
Flight Nurse / Flight Paramedic (FW)
Strike Team Leader
Other
Emergency Contact Name
First Name
Last Name
Pilot Applicant?
Yes
Deployment Length Interest:
*
Please Select
< 7 day deployments
4-14 day deployments
14-28 day deployments
> 28 day deployments
Choose how long of a deployment you are able to entertain in your life situation.
Emergency Contact Phone Number
-
Area Code
Phone Number
Qualification Verification
The following fields are used to validate certifications and run the necessary driver background for insurance coverage.
Date of Birth:
*
-
Month
-
Day
Year
Date
Driver's License Number:
*
If from state other than your home address, please list state of your DL issuance
Social Security Number:
*
9 digits, no dashes
File Uploads
Please upload any and all of the requested documents below for full consideration. This will speed up the process of getting you credentialed for deployment.
Valid State EMS Card?
I Currently Possess a valid state EMS card
I DO NOT Currently Possess a valid state EMS card
Resume
Browse Files
Cancel
of
Driver's License
*
Browse Files
Cancel
of
Covid -19 Vaccine
Browse Files
Cancel
of
National Registry
Browse Files
Cancel
of
State EMS Certification
*
Browse Files
Cancel
of
ACLS
Browse Files
Cancel
of
CPR Certification
Browse Files
Cancel
of
FAA Pilot's License
Browse Files
Cancel
of
State Nursing License
Browse Files
Cancel
of
Emergency Vehicle Operator
Browse Files
CEVO, EVOC, or DDC4 approved course. Department certificates are not accepted.
Cancel
of
HazMat Awareness (or higher)
Browse Files
Cancel
of
Hepatitis B Vaccination Record or Waiver
Browse Files
Waiver can be found on website if needed. Apply (emsteam.net)
Cancel
of
OSHA Questionnaire
Browse Files
Form - OSHA Respiratory Questionnaire for Occupational Health - high_use (wsimg.com)
Cancel
of
W-4
Browse Files
2022 Form W-4 (irs.gov)
Cancel
of
Direct Deposit Form
Browse Files
Can find form on website Direct Deposit Form.pdf (wsimg.com)
Cancel
of
Save
Submit Form
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