Atlanta Fire Rescue Department Paramedic Program Application
Please ensure you have all required information before submitting
Full Name
*
First Name
Middle Name
Last Name
Suffix
Todays' Date
*
-
Month
-
Day
Year
Date
Home Address (Must be a physical address)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Phone Number
*
Please enter a valid phone number.
Work Email Address:
*
example@example.com
Alternate Email Address:
*
example@example.com
EMT Licensure Level
*
EMT Intermediate
EMT Advanced
EMS State License Number
*
NREMT Number (if applicable)
Shift (For AFRD members only)
A Shift
B Shift
C Shift
40 hour workweek
Station (For AFRD members only)
Please Select
Station 1
Station 2
Station 3
Station 4
Station 5
Station 6
Station 7
Station 8
Station 9
Station 10
Station 11
Station 12
Station 13
Station 14
Station 15
Station 16
Station 17
Station 18
Station 19
Station 20
Station 21
Station 22
Station 23
Station 24
Station 25
Station 26
Station 27
Station 28
Station 29
Station 30
Station 31
Station 32
Station 33
Station 34
Station 35
Station 36
Station 37
Station 38
Station 39
Station 40
EMS Supervisor's Name
*
First Name
Last Name
EMS Supervisor Email
*
example@example.com
Officer In Charge (OIC) Name
First Name
Last Name
OIC Email
example@example.com
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Signature
Supplemental Documentation
A Copy of Proof of Age (ex. Valid driver's license/passport)
*
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A copy of valid EMT-I or AEMT license
*
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A copy of current BLS card, document must include front and back images
*
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Proof of high school diploma/GED or college transcript
*
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Letter of Intent-Please answer these three questions and include anything else you believe to be pertinent regarding your intention to begin your paramedic journey: Limit letter of intent to only one typed page 1) What is your motivation for pursuing your paramedic certification/licensure? 2) What is your vision of the outcome you hope to achieve? 3) How do you plan to commit the time necessary to be successful in the completion of your paramedic journey?
*
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Letter of Recommendation-One
*
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Letter of Recommendation -Two
*
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Submit
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