Medical Specialist Please enable JavaScript in your browser to complete this form.Progress on this application cannot be saved. You must complete and submit your application in one sitting.Required InformationYou must complete and submit all items in this section for your application to be considered.Name *FirstLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmployer *Current Position With Employer *Email Address *Cell Phone Number *Are you a US Citizen? *YesNoYou must submit the following documentation for your application to be considered (ONLY PDF FILES ARE ACCEPTED) EMT/P, RN, RN-P, PA license ICS 100 ICS 200 ICS 700 ICS 800 Resume Letter of Recommendation from Agency Chief/Point of Contact Essay (no more than 250 words about why you want to be a member) Driver’s License Please upload your EMT/P, RN, RN-P, PA license * Drag & Drop Files, Choose Files to Upload Please upload your ICS 100 * Drag & Drop Files, Choose Files to Upload Please upload your ICS 200 * Drag & Drop Files, Choose Files to Upload Please upload your ICS 700 * Drag & Drop Files, Choose Files to Upload Please upload your ICS 800 * Drag & Drop Files, Choose Files to Upload Please upload your Resume * Drag & Drop Files, Choose Files to Upload Please upload your recommendation letter from an Agency Chief/Point of Contact * Drag & Drop Files, Choose Files to Upload Please upload your essay on why you want to join the Task Force * Drag & Drop Files, Choose Files to Upload Please upload a copy of your driver's license * Drag & Drop Files, Choose Files to Upload Recommended Information (ONLY PDF FILES ARE ACCEPTED)Please check those certifications that you have and upload copies belowPALS CardBTLS CardACLS CardMedical Specialist Training CourseGPS OperationsRope Rescue AwarenessTrench Rescue AwarenessDuties of EntrantRope Rescue SkillsEnhanced Operations in a Contaminated EnvironmentFEMA USAR OrientationWMD AwarenessBlood Borne PathogensCritical Incident Stress ManagementHazMat Operations for First RespondersStructure Collapse AwarenessConfined Space AwarenessWater Rescue AwarenessICS 300ICS 400Swiftwater Rescue Technician 1&2Wide Area SearchSubmit recommended files here Drag & Drop Files, Choose Files to Upload You can upload up to 22 files. Submit
