EMT Academy Application EMT Academy Application Current Class Schedule: Dates: October 17th 2023 – February 8th 2024 Length: Twelve (12) Weeks Class Days: Tuesday & Thursday: 9:00am – 5:30pm Saturday (Every Other): 9:00am – 5:00pm Name* First Last Driver License #* Phone*Email* How did you hear about our EMT Academy?* Highest level of education*GED or High School Graduate required List any Academic Degrees and/or Professional Certifications/Licenses* List any previous EMS, Medical and/or Fire Department experience* List any community service involvement in prior (5) five years* Resume (if available)PDF format required Max size 2MBAccepted file types: pdf, doc, Max. file size: 2 MB.Please provide a few interesting facts about yourself! Include your goals, hobbies, anything!*AcknowledgementIn the sections below, please mark the checkboxes to acknowledge each item. Marking each checkbox acknowledges that you understand each minimum requirement must be met prior to acceptance into the EMS Academy. Documentation is not required to submit your application and begin the enrollment process, however if available you can choose to upload these items now using the Upload Document(s) section. Please contact our Education Coordinator (Education@UniversalMacomb.com) or Human Resources Department (HR@UniversalMacomb.com) with questions or for assistance. Immunization Records*Immunization Records must be submitted prior to acceptance into the course, however they are not required for the initial submission of your application. If you have been immunized in the State of Michigan, you may be able to download your Immunization Record from the Michigan Department of Health & Human Services – Immunization Portal Immunization records may also be obtained from your physician. Immunization Records – Acknowledged Medical Exam Form*Applicants accepted into the EMS Academy must complete a Medical & Fitness Examination with their physician of choice prior to the start of the course. Please provide your physician with the following Medical Examination Form. Medical Examination Form – Acknowledged Minimum Requirements*Mark the checkboxes to acknowledge the following additional minimum requirements: Must be at least 18 years of age Copy of valid State of Michigan Driver’s License Copy of High School Diploma or GED Proof of immunization – COVID-19 Proof of Tuberculosis Test (within last 12-months) Proof of immunization – MMR Proof of immunization – Varicella Proof of immunization – PPD (within last 12-months) Proof of immunization – Tetanus (within last 10-years) Proof of immunization – Hepatitis B (optional) Upload Document(s)PDF format required Max size 2MB Drop files here or Select files Accepted file types: pdf, doc, Max. file size: 2 MB. CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ
