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NOTE: Have you ever been convicted, adjudged guilty by a court, pled guilty or pled nolo contendere to any crime (excluding traffic violations), whether or not sentence was imposed?

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Have you ever been a student in any paramedic program:

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Diploma:

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PLEASE CHOOSE HOSPITAL PREFERENCE TO BE USED IN AN EMERGENCY:

  • Parkland Health Center,Farmington/Bonne Terre, MO
  • Other
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