• Southern Regional EMS Employment Application

    Southern Regional EMS is an equal opportunity employer. Complete every required field and upload clear, current copies of your credentials. Applications submitted without credentials cannot be processed.

  • Applicant Information

  • Format: (000) 000-0000.
  • Are you at least 18 years of age?*
  • Do you have a valid driver's license?*
  • Are you legally authorized to work in the United States?*

  • Position Applied For

  • License Level Applying For*
  • Employment Type*
  • Shift Preference
  • Earliest Date Available to Start*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Certification and Licensure

  • Georgia License Expiration Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Current NREMT Certification?*
  • Certifications Currently Held
  • Has any EMS license or certification ever been suspended, revoked, or placed on probation?*

  • Credential Upload

  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof

  • Employment History

  • May we contact your current employer?

  • Additional Information

  • Certification and Consent

  • Date of Application*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: