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POSITION APPLIED FOR?
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HAVE YOU HAD ANY MAJOR TRAFFIC VIOLATIONS OR LICENSE SUSPENSIONS?
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Has your EMT/Paramedic certification or standing order ever been suspended or revoked?
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What is your National Registry EMT/Paramedic License Number & Expiration Date?
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What is your New Mexico State EMT License Number & Expiration Dates or Student Status?
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APPLICANT CERTIFICATION & AGREEMENT:
(Read carefully before signing) I certify that this information contains no willful misrepresentation or falsification and that the information given by me is true and complete the the best of my knowledge and belief. I understand that if employed, misleading or falsified statements on this application may be considered cause for dismissal.
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Home
Services
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Contact
Employment
BILLING
Non-Emergency Medical Transport
