TSC EMS Paramedic Application
Even though it is after June 1st please apply!!
Name
*
First Name
Last Name
TSC S Number:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
EMS Affiliation
EMS Affiliation Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Length of Active EMS Involvement:
EMS Certification Number
State Issuing the Certification Number
Date Certification Issued:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Certification Expires:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type a question
I understand that successful completion of the pre-requisites by the deadline is necessary before my application is completed.
I understand that acceptance of the application does not constitute an offer or promise of training, nor an offer or promise of employment following training.Any falsification of this document will cause this application to be rejected.
I understand that background checks, a completely clean drug screening and immunization uploads are required by the stated deadlines for full admission into the program. (Disqualifying Offenses for the background checks are listed on cccs.castlebranch.com)
Submit
Should be Empty: