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2. Instructions
   Please indicate the items you wish to order below. Please be aware that part time employees are restricted to a maximum of two pairs of pants, one t-shirt, one fleece pull over, and two polo shirts only. If you do not require two items then please only order the number of items you need.
4. First Name
5. Last Name
7. Certification

   1. EMT
   2. AEMT/Advanced EMT
   3. Paramedic
   4. Licensed Paramedic

   Please indicate your certification level as you wish it to appear on your uniforms.
11. T-Shirt

    1. Small
    2. Medium
    3. Large
    4. X-Large
    5. XX-Large
    6. XXX-Large
    7. 4X-Large
    8. 5X-Large
    9. 6X-Large

    Select the appropriate size t-shirt. Please ensure that the size you order is of sufficient size to remain tucked in at all times. Limit 2.

12. Number of Items Needed

    Please indicate the number of items you need. Only order the number of items necessary. Limit 2.

14. Polo

    1. Small
    2. Medium
    3. Large
    4. X-Large
    5. XX-Large
    6. XXX-Large
    7. 4X-Large
    8. 5X-Large
    9. 6X-Large

    Select the appropriate size polo shirt. Please ensure that the size you order is of sufficient size to remain tucked in at all times. Limit 2.

15. Gender

    1. Male
    2. Female

    Please indicate the gender cut of the item you wish to order.
16. Number of Items Needed

    Please indicate the number of items you need. Only order the number of items necessary. Limit 2.

18. Job Shirt (Fleece Pull Over)

    1. Small
    2. Medium
    3. Large
    4. X-Large
    5. XX-Large
    6. XXX-Large
    7. 4X-Large
    8. 5X-Large
    9. 6X-Large

    Please indicate the size of job shirt you wish to order. Please be aware that the 5.11 brand tends to run long while the Propper tends to run much shorter. Please keep this in mind when making your selection. Please be aware 5.11 brand is unavailable in sizes 4X-Large and higher. Limit 1.

19. Brand

    1. 5.11
    2. Propper

    Please indicate the brand of job shirt you wish to order. Please be aware that the 5.11 brand tends to run long while the Propper tends to run much shorter. Please keep this in mind when making your selection.
20. Number of Items Needed

    Please indicate the number of items you need. Only order the number of items necessary. Limit 1.

22. Pants
    Please indicate the waist size and hem length (in that order) of the pants you wish to order.
23. Brand

    1. 5.11
    2. Propper

    Please indicate the brand of pant you wish to order.
24. Gender Cut

    1. Male
    2. Female

    Please indicate the gender cut of the pant you wish to order.
25. Number of Items Needed

    Please indicate the number of items needed. Only order the number of items necessary. Limit 2.

27. Belt

    Please indicate the waist of the belt you wish to order. Limit 1.

29. Velcro Name Patches Ordering Information

    Part-time employees are not issued safety vests or hi-vis winter jackets. If you need either one on shift, the on-duty Captain will issue one for the shift and your Velcro name patch may be applied.

31. Velcro Name Patches

    Please indicate the number of Velcro name patches you wish to order. Limit 2.

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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