Paramedic Intern Application
After filling the details click on the SUBMIT button.
*
indicates required fields
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Last Name:
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First Name:
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Middle Initial:
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Phone#:
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Email:
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Street Address:
*
City:
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State:
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Zip:
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CPR:
Yes
No
CPR Expires:
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CEVO/EVOC:
Yes
No
*
Level of Licensure:
EMT Basic
EMT Intermediate Tech
EMT Intermediate (I99)
EMT Paramedic
None
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Wisconsin License:
Yes
No
Wisconsin License #:
National Registry:
Yes
No
*
ICS 100:
Yes
No
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NIMS 700:
Yes
No
*
Why do you want to be a DGEMS intern?:
*
How did you hear about the intern program?:
After filling the details click on the SUBMIT button.
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