Paramedic Program Application

Paramedic Program Application

Please complete this application in its entirety. Upon submitting the application your non-refundable application fee of $200 will be processed. Please note that submitting an application does not guarantee acceptance into the program. Once the application is completed and payment is received, your application will be reviewed. Please allow for 10-14 days for our team to contact you with the next steps in the process.
Entrance Requirements
- 18 years of age and;
- Driver's License and;
- Hold a high school diploma or equivalent and;
- Meet the technical standards for Paramedic (listed below);
- Currently certified Vermont State EMT or AEMT and maintain throughout the length of the program.
- AHA BLS CPR
- Submit application and all supporting documents
- Successful completion of interview
- Read on a 12th-grade level
Technical Standards Required

All students must provide a letter of attestation from Primary Care Provider prior to the program start date certifying that you can perform the following job specific physical requirements of a Paramedic:
- Lifting and Carrying – Ability to lift up to 125lbs individually or 250lbs with assistance and push/pull up to 100lbs
- Dexterity – Students must be able to write and type, pinch, pick up, grasp, squeeze as well as worth with fingers
- Tactile – Students must have normal tactile ability to be able to assess pulse, temperature, size and shape
- Endurance – Students must be able to stand, stoop, move quickly, do repetative movements, walk, climb stairs, back-up stairs, push/pull, crouch, kneel, bend and twist for extended periods of time
- Hearing – Students must be able to hear sounds at varying levels
- Vision – Students must be able to see from 20 inches to 20 feet and beyond, use depth perception and peripheral vision, and distinguish color and color intensity
- Emotional stability – Students must be able to adapt to ever-changing, unpredictable and stressful situations, and manage and monitor their own emotions
Required documents prior to beginning the application:
- High School Diploma/GED/High education certification
- NREMT/AEMT Certification
- AHA BLS CPR
- ICS 100
- ICS 200
- ICS 700
- Hazmat Awareness
- Driver’s License
- Two (2) professional letters of recommendation – head of service, supervisor,
- medical director, etc.
- 50 patient contacts verified by your Head of Service (form attached)
Application Questions:
Personal Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemaleOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Last 4 Social Security*
Would you like additional information on temporary housing during the program?*

YesNo
Employment Information
Current Primary Employer*
Work Status*

Full-timePart-timePer Diem
How long have you been employed by this service*
Employer Phone Number*
Please enter a valid phone number.
Please list any other agencies or companies you currently work for*
Licenses and Certifications
Current level of certification*

EMTAdvanced EMT
Upload NREMT/AEMT Card*

Cancelof
Upload State License(s)*

Can add multiple files at one time
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Has your EMT certificate or authorization to practice ever been revoked or suspended?*

NoYes
Have you ever been convicted of a felony?*

NoYes
Have you ever been convicted of any offenses related to controlled substances?*

NoYes
Military
Have you ever been or are you currently part of the military?*

NoYes
Drivers License
Upload current driver's license*

Cancelof
Has your driver’s license ever been revoked or suspended?*

NoYes
Education
Name of High School*
Graduation Date *

MonthDayYear
Date
Name of post-secondary school attended
If you attended college what did you major in?*
Are you currently enrolled in college?*

NoYes
References

• Please list three (3) professional references Name, contact information, relation
Professional Reference 1*
Professional Reference 2*
Professional Reference 3*
Personal Statement
• Please submit a 200 (minimum) word essay. Things to include: How long have you been actively involved in EMS? Why did you get into EMS? Why do you want to be a paramedic? What are you strengths and weaknesses in EMS? Why have you chosen to apply to this program?*
Other Uploads
Head of Service verification form*

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Professional letters of recommendation (2) – examples: supervisor, head of service, medical director, mentor*

Cancelof
ICS 100*

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ICS 200*

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ICS 700*

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Hazmat Awareness*

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AHA BLS CPR *

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Affirmation Statement

I hereby affirm that all the information provided is true and correct to the best of my knowledge.
Signature*

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Non-refundable Application Payment - $200

As part of the application process for the Rescue Inc Paramedic Program, applicants are required to submit a non-refundable application fee of $200. This fee is used to cover the administrative costs of processing applications and is not refundable under any circumstances, regardless of the outcome of the application. Fee Application to Tuition: If the applicant is accepted into the program, the $200 application fee will be applied as a credit toward the total tuition cost. Acknowledgment of Understanding: By submitting the application fee, applicants acknowledge and agree to the terms of this policy, including the non-refundable nature of the fee and the conditions under which it is credited toward tuition.

Application Fee

$200.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

*Your application will be placed on file, you will be contacted by VEMSA faculty to schedule a date and time for your interview*
Should be Empty:

Paramedic Program Application

Application Questions:

Personal Information

Employment Information

Licenses and Certifications

Military

Drivers License

Education

References

Personal Statement

Other Uploads

Affirmation Statement

Non-refundable Application Payment - $200

*Your application will be placed on file, you will be contacted by VEMSA faculty to schedule a date and time for your interview*

Your application will be placed on file, you will be contacted by VEMSA faculty to schedule a date and time for your interview