Ambulance Incentive Form

Welcome Back, {name}

Qualification: {qualification}

Incentive Period: {incentivePay}
EMT Pay

$75/per shift

$20/call at will
EMR Pay

$60/per shift

$15/call at will
Six (6) Hour Shifts
Three (3) Hour Shifts

Three hour shifts MUST add to a six hour shift. An odd number of three hour shifts will not qualify for incentive.
Calls Not On Shift

Call number format must be 26-#### (including the dash).
Six Hours Total
Three Hours Total
At Will Total
Total Incentive
{totalIncentive}.00
Total Standby
I, {name}, attest that the information on this document is accurate to my knowledge. I also attest that I qualify for ambulance incentive and have adhered to the policy.
Signature*
Please verify that you are human*
Should be Empty: