Bergen County Technical Schools

Which program are you applying for?

Bergen County EMS Adult & Continuing Education

General Information

First Name *

Middle Name

Last Name *

Date of Birth *

Gender

Social Security Number

999-99-9999

Phone *

Cell phone *

Business Phone

Email *

Address *

City *

State *

Zip Code *

Emergency Contact Name

Emergency Contact Phone

Are you a Bergen County Resident? ($25 Out of County Fee if no) Yes No

Race

NJ State 6 Digit EMT ID

NJ State EMT Expiration Date

Department Name *

Highest Level of Education Completed

Education, Training, Military History, Work Experience

High School, Secondary, GED

Name and Location

Date Attended

Type of Diploma

Post Secondary, College/University, Technical Training

Name and Location

Date Attended

Type of Diploma

Military

Branch of Service

U.S.A. or other
U.S.A. Other

Discharge Date

Please refer to the Full-Time Day Program section of the Bergen County Technical Schools (BCTS) Adult & Continuing Education catalog, brochure or website for additional information about the full-time training programs currently available. BCTS students are provided with the finest training available at the most affordable tuition and fees. BCTS students also receive career counseling, vocational testing, job placement services, interview and resume preparation workshops, and financial aid (if qualified).

My first choice for job training

My second choice for job training

I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that any misrepresentation or omission of pertinent facts is cause for rejection of my application or termination from BCTS Adult & Continuing Education Full-time Day Program. I authorize the companies, schools or persons named herein to provide information about me. If I am enrolled, I hereby agree to abide by all school policies and regulations. I also understand that acceptance into any of the training programs depends upon the availability of the programs and the review and verification of all required documents by program administration.

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