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2. First Name*

3. Last Name*

5. City

6. State

8. Phone Number

9. Email Address

11. Do you have an NREMT certification?
    -- Select One --ParamedicAEMTEMTNone

12. Are you licensed to work as a paramedic in Louisiana?
    -- Select One --YES NO

14. Do you have EMS experience? Please tell us about it.

16. Do you have any specific questions about working for East Baton Rouge Parish EMS that we can answer for you?

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17. 1. Receive an email copy of this form.
18. Email address

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19. Submit

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