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Address *
City *
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Email Address *
Phone*
Are you willing to work full-time?	YesNo
Are you willing to be scheduled in different shifts?	YesNo
Do you have a valid Driver's License?	YesNo
Are you fluent in speaking English?	YesNo
What other languages do you speak/write besides English?
Are you CPR Certified?	YesNo
Are you trained with First Aid?	YesNo
Have you had previous experience in Emergency or Non-Emergency Medical Transportation? (Please describe in detail)
How soon can you start?
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