Adair County Ambulance District
ADAIR COUNTY AMBULANCE
Kirksville, MO - (660) 665-0000
"Teamwork with commitment to excellence and compassion."
Online Bill Pay
Crew Webmail
Home
About ACAD
Mission, Vision, and Values
History of the District
Board Members
Public Notices
Medical Directors
Leadership
Office Staff
The Crew
Vehicles and Equipment
Internal Training Program
Contact Us
Patient / Ambulance Services
Online Bill Pay
Patient Forms
HIPPA Privacy Notice
Request For Standby
Internal Training Conference Room Request
Patient Resources
Patient Billing Dept Contact
Employment
Benefits and Job Descriptions
Open Positions and Application Link
ACAD FULLTIME EMT ACADemy
Transparency in Coverage
Surplus Property
ACAD Annual Kids Day
Car Seat Checks
ACADemy Training Center
ACADemy Mission, Vision & Values
ACADemy Facilities
ACADemy Instructors & Staff
ACADemy Classes & Certifications
ACADemy Online EMT Program
ACADEmy In-Class EMT Program
Paramedic (NRP)
Community Paramedic
ACADemy Certifications Offered
Basic Life Support (BLS) Provider Course *Includes HCP & Heartsaver Courses
Corporate CPR Training
Basic Life Support (BLS) Instructor Course
Advanced Cardiac Life Support (ACLS) Provider Course
Advanced Cardiac Life Support (ACLS) Instructor Course
Emergency Pediatric Care (EPC) Provider Course
Prehospital Trauma Life Support (PHTLS) Provider Course
Daycare/Babysitter Safety Course
Request Info About Training
Public Notices
Community Paramedic Application
Community Paramedic Application
Personal Information
Full Legal Name
*
Date Of Birth
*
Address
*
Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Cell Phone
*
Home Phone
Work Phone
Email Address
*
Education
High School
Graduation Date
Other Education (vocational training, college, etc.)
School
Graduation Date
Degree/Certificate
EMS Education
School
Graduation Date
Instructor
National Registry #
State License #
BLS Expiration Date
Work History
Name of Employer
Dates of Employment
Position
Reason for Leaving
Name of Employer
Dates of Employment
Position
Reason for Leaving
Ems Related Certifications
Certification
Expiration Date
Certification
Expiration Date
Certification
Expiration Date
Have you ever been convicted of a misdemeanor, felony, DUI or DWI or do you have any charges pending?
*
Yes
No
If yes, please attach a separate page giving a brief description of the incident. Include dates and penalties assessed.
Have you ever been subject to limitation, suspension, or termination of your right to practice in a healthcare occupation or voluntarily surrendered a healthcare licensure in any state or to an agency authorizing the legal right to work?
*
Yes
No
If yes, please attach a separate page giving a brief description of the incident. Include dates and penalties assessed.
How did you hear about the Community Paramedic Program
*
Facebook
Online Ad
Previous Student
Radio Advertising
Website Search
Other
Other
reCAPTCHA
If you are human, leave this field blank.
Submit