GEMRU Responder Background

GEMRU Background

This form is to be completed during the second round of the formal application cycle. Please do not complete this form until instructed by GEMRU.

Applicant Information

Name(Required)

First Middle Last

UFID #(Required)

Only UF Students are allowed to join GEMRU.

Date of Birth(Required)

Place of Birth(Required)

DL#/ID#(Required)

ID Type(Required)

Example a Class C License

Issuing State/Nation(Required)

LAST 4 of Social Security Number(Required)

Race(Required)

Sex(Required)

Eye Color(Required)

Hair Color(Required)

Height(Required)

Weight(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

GEMRU Position

Select the providers level of care(Required)

EMR

EMT

EMT/LEAD

EMT License Number(Required)

Social Media

By submitting this application, you agree to accepting a friend request by UFPD.

Facebook - If not applicable, please write N/A(Required)

Instagram - If not applicable, please write N/A(Required)

Twitter - If not applicable, please write N/A(Required)

Other - If not applicable, please write N/A(Required)

Emergency Contact

Name(Required)

First Last

Relationship(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Photograph(Required)

Accepted file types: jpg, jpeg, png, gif.

Please take a photograph of yourself on a neutral wall color and attach to your application

This field is for validation purposes and should be left unchanged.

GEMRU Responder Background

GEMRU Background

Applicant Information

GEMRU Position

Social Media

Emergency Contact

Resources

Campus

Website

Gator Emergency Medical Response Unit

Gator Emergency Medical Response Unit

GEMRU Responder Background

GEMRU Background

Applicant Information

GEMRU Position

Social Media

Emergency Contact

Resources

Campus

Website