Limited Term Employment Application
* indicates required fields 
  *Last Name:
  *First Name:
  *Middle Initial:
  *Phone Number:
  Email:
  *Street Address:
  *City:
  *State:
  *Zip:
  *CPR:  Yes
 No
  CPR Expires:
  *CEVO/EVOC:  Yes
 No
  *Level of Licensure:
  *Wisconsin Licensure:  Yes
 No
  Wisconsin License Number:
  National Registry:  Yes
 No
  NREMT#:
  *ICS 100:  Yes
 No
  *NIMS 700:  Yes
 No
  *Why do you want to be a DGEMS employee?:
  *How did you hear about DGEMS?: