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#CCT-H003-904505
Supplemental Questionnaire

Last Name
First Name
1

Do you have a high school diploma or an equivalency certificate (e.g., G.E.D., California High School Proficiency Certificate)? 
Yes No
2

Are you at least 19 years of age? 
Yes No
3

Do you possess a current and valid California Emergency Medical Technician (EMT) Certification issued by the State of California? 
Yes No
4

Do you possess a valid California Driver License with an Ambulance Driver certificate/endorsement?  
Yes No
5

Do you have any combination of 500 hours of verifiable work experience as an EMT (on an ambulance or first responder vehicle) and/or hours of documented ambulance ride-along as a member of the San Francisco Fire Reserves within the last three years?

OR

Do you have any combination of 1,000 hours of verifiable work experience as an EMT (on an ambulance or first responder vehicle) and/or hours of documented ambulance ride-along as a member of the San Francisco Fire Reserves within the last five years? 
Yes No