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 Name Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone: *

Area Code Phone Number
E-mail: *
Areas Of Interest: *

EMT / AEMT Paramedic Ambulette Driver EMS Driver
Emergency Contact Name

First Name Last Name
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.
Resume

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Cancel of
Driver's License *

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Cancel of
Are you currently vaccinated against Covid-19? *

Yes No
Covid -19 Vaccine

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Cancel of
National Registry

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Cancel of
Are you currently a licensed EMT/Paramedic in Ohio?

Yes No
Ohio State EMS Certification

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Cancel of
ACLS

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Cancel of
CPR Certification

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Cancel of
Emergency Vehicle Operator

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CEVO, EVOC, or DDC4 approved course. Department certificates are not accepted. Cancel of
Hepatitis B Vaccination Record or Waiver

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Waiver can be found on website if needed. Apply (emsteam.net) Cancel of
Should be Empty:

Ohio Ground Application

Qualification Verification

File Uploads