California State University Dominguez Hills EMT Program Interest Survey

Thank you for your interest in CSUDH's EMT Program! By filling out this form, you will be taking the next step to starting a career as an Emergency Medical Technician! This is a great opportunity for you to begin a career in the medical field, fire department, and beyond! Please help us connect you with the right person by completing the questionnaire.

Are you inquiring about CSUDH's EMT Program, hiring opportunities at MedReach Ambulance, or both? *

First Name *

Last Name *

Email *

Phone *

Address

City

State

Postal code

Date of Birth (Format: MM/DD/YYYY)

Job Title

Organization

How did you hear about CSUDH's EMT Program?

By submitting this form, you agree to be contacted by one of our recruiting personnel. We will not use or sell your contact information except for our own hiring and recruiting purposes. You may receive email updates, memos, or informational emails.