Ohio Ground Application Form

Ohio Ground Application

This application is to be used ONLY for those wishing to become employed by EMS Team, LLC. Must possess Ohio state EMS certification for consideration.
Full Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone:*

Area CodePhone Number
E-mail:*
Areas Of Interest:*

EMT / AEMTParamedicAmbulette DriverEMS DriverOther
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Qualification Verification

The following fields are used to validate certifications and run the necessary driver background for insurance coverage.
Date of Birth:*

MonthDayYear
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.
Resume

Browse Files

Cancelof
Driver's License*

Browse Files

Cancelof
Are you currently vaccinated against Covid-19?*

YesNo
Covid -19 Vaccine

Browse Files

Cancelof
National Registry

Browse Files

Cancelof
Are you currently a licensed EMT/Paramedic in Ohio?

YesNo
Ohio State EMS Certification

Browse Files

Cancelof
ACLS

Browse Files

Cancelof
CPR Certification

Browse Files

Cancelof
Emergency Vehicle Operator

Browse Files
CEVO, EVOC, or DDC4 approved course. Department certificates are not accepted. Cancelof
Hepatitis B Vaccination Record or Waiver

Browse Files
Waiver can be found on website if needed. Apply (emsteam.net) Cancelof
Should be Empty:

Ohio Ground Application

Qualification Verification

File Uploads