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State
Are you certified in the state of Texas? YesNo
Are you certified as?
ECA EMT-B EMT-I EMT-P
Licensed Number:
Valid from and to:
Are you looking for? Full TimePart Time
Are you over 18? YesNo
Do you have a Texas Driver's License? YesNo
Do you own a car? YesNo
Do you have any traffic violation? YesNo
If Yes, explain:
What shifts would you prefer?
Days Nights PM Live-in
Previous experience
Name of Company
Time Frame
Starting Pay

How did you hear about us?

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