Uniform Requisition Form
Complete this form for your annual uniform order. Select items that you need for the year and submit the form. Orders will automatically notify Lieutenant Dirks in Logistics.
First and Last Name
*
Work Email
*
Credential
EMT
AEMT
Paramedic
CCEMT-P
Title
List your rank or title for uniform embroidery
Hat
Please Select
Richardson 112 Trucker Hat
Richardson 115 Low Profile Trucker Hat (Great option for smaller heads)
Toboggan/Beanie
Please Select
Navy with Leather Patch Front
EMS Badge (Only if you do not have one)
Please Select
New Employee Issued
Replacement
T Shirts
Select size and Quantity
EMS T-Shirts (Select QTY in next Question)
Please Select
XS
S
M
L
XL
XXL
3XL
EMS T-Shirt QTY
Please Select
1
2
3
Part-Time (1) Full-Time (2) 12-hour (3)
Raincoat
Select STYLE, size and Quantity
Raincoat
Please Select
Men's High Viz Tactix System FULL TIME ONLY!
Women's High Viz Tactix System FULL TIME ONLY!
Men's Navy Parka System ADMIN ONLY!
Women's Navy Parka System ADMIN ONLY!
Part Time Rain Coat by Liberty
Raincoat Size
Please Select
XS
S
M
L
XL
2XL
3XL Men's ONLY!
4XL Men's ONLY
Layering System Choice
Please Select
Full Raincoat System
Raincoat only (no liner)
Liner only (no raincoat)
Notes
Submit
Should be Empty: