Solicitud de Ingreso a FREMS

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Email *

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Nombre *

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Edad *

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Teléfono de contacto

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E-mail *

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Patrono actual

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Supervisor

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Profesión *

TEM-B

TEM-P

TEM Provisional

MD

Otra

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Tres (3) referencias profesionales (nombre y teléfono) *

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Certificaciones vigentes *

BLS (American Heart Association)

ACLS (American Heart Association)

PALS (American Heart Association)

PHTLS (o ITLS o ATLS)

Rescate Vehicular

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¿Por qué quieres pertenecer al equipo de FREMS? *

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