猫咪社区
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Nightingale ride-along application
Application date
Name
Email
Phone
Is it okay for the flight crew to text you at this number?
Yes
No
Years experience as an RN or EMS provider
Current EMS/Fire agency or Hospital affiliation
Years of affiliation
Title
Current supervisor
Work phone
Work email
Present weight fully clothed (lbs):
Height
Your Ride-Along will be scheduled Monday-Friday 0700hrs. to 1700 hrs. Please list your first 3 choices (Day and Time) that you are available for a Ride-Along.
Do you have any physical limitations, or medical history that could affect your experience? If so, please list:
Briefly explain your interest in our Ride-Along Program and what you expect to gain from your experience.
Submit