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First Name
Last Name
Street Address
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City
Region/State/Province
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Home Airport
Are you currently on any companies active roster?
Secondary Airport
Shirt Size
Please specify your availability to deploy for a minimum of 14 days on 24-48 hour notice (We are looking for people who want to work fire season from start to finish (average 63 total days)
Have you worked for Wildland Medics in the past
If yes, please provide dates
ARE YOU A MILITARY VETERAN
YES
NO
ARE YOU A RESERVIST
YES
NO
State Certifications
EMT
AEMT
Paramedic
National Certification
EMT
AEMT
Paramedic
State License Number
National License Number
I have the following Certifications
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Introduction to Incident Command System (IS-100)
An introduction to the National Incident Management System (IS-700)
Firefighter Training (S-130)
Introduction to Wildland Fire Behavior (S-190)
Human factors in the Wildland Fire Service (L-180)
Annual Wildland Fire Safety Refresher (RT-130) (current year)
Arduous Work Capacity Fitness Test (Pack Test))
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