If you are a nurse looking for a new and exciting job or a paramedical examiner looking to extend your area, please fill out the form below and either print it out and fax it to us or simply click the Submit button below. You will receive a response once we receive your application.

Have you ever been convicted for any violation(s) of law including moving traffic violations or juvenile convictions committed after your fourteenth birthday? Yes No. If yes, please provide the following: Description of offense: Statute or ordinance (if known): Date of charge Date of conviction County, city and state of conviction For additional convictions please send the same information above in a separate e-mail message to mps@insuranceexams.net.