EMT Course Application
Please fill out the questions below to your best ability.
Name:
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Legal First Name
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Email:
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example@example.com
Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
Do you have a Drivers License
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BACK of Drivers License or State ID
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Illinois requires a High School / GED Diploma OR Transcript in order to take the EMT-B Certification exam. A copy of your High School / GED Diploma OR Transcript will be required. By clicking 'Yes' you acknowledge that you have one of the required documents. If you need help obtaining these documents please contact us at education@eliteamb.com
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YES
NO
High School Transcript OR High School Diploma OR Copy of GED
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How do you want us to contact you?:
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Email
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How did you hear about us?:
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Desired Training Facility:
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Please Select
Orland Park Day Course
Orland Park Night Course
Schiller Park Day Course
Schiller Park Night Course
Hickory Hills Day Course
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North Aurora Day Course
North Aurora Night Course
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Select One
Prior to this class, what medical experience do you have?:
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EMR
Fire Department
CPR
High School Anatomy
CNA
No Experience
Will you be 18 years old by the end of the class?
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Yes
No
Do you plan on working for Elite after the EMT Course?
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Yes
No
By selecting yes, you understand that you WILL NOT be able to take your National Certification Test with a criminal background. By selecting yes, you agree that you have read the NREMT Criminal Convictions policy, and you understand that if you have convictions or ongoing investigations, you will not be able to test and receive your EMT-B Certification.
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Yes
No
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 Technician 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 Technician course and that you have a Highschool diploma or GED. Also by agreeing, you understand that Elite Medical Transportation, LLC's Emergency Medical Technician course is non-refundable for any reason.
Agreement
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I agree to these terms & conditions.
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