EMR Course Application

  • EMR Course Application

    Please fill out the questions below to your best ability.
  • Format: (000) 000-0000.
  • How do you want us to contact you?*
  • Prior to this class, what medical experience do you have?:*
  • Are you 18-years-old or older?*
  • Do you plan on working for Elite after the EMR Course?*
  • Are you willing to undergo a criminal background check*
  • Do you have a valid driver's license?*
  • Do you have LESS THAN 2 negative moving violations in the past 3 years?*
  • Can you provide a copy of your High School Diploma, GED, or Transcript for this course?*
  • Are you willing to undergo a criminal background check upon registration?*

  • Privacy Policy

    Notice: Elite Medical Transportation, LLC will not sell or give your personal information to any third-party company, person, and/or entity.

  • Terms & Conditions

    By agreeing to these terms & conditions, you understand that submitting this form does not grant automatic entry into Elite Medical Transportation, LLC's Emergency Medical Responder Program. By agreeing to these terms & conditions, you also acknowledge that you must be at least 18-years-old or older by the time you start the Emergency Medical Responder course and that you have a Highschool diploma or GED. Also by agreeing to these terms, you understand that this course is $200.00 USD, which is only refundable after 90-days of successful licensed employment as an Emergency Medical Responder with Elite Medical Transportation, LLC.
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