Apply Now

If you are a member of the Law Enforcement, Firefighter or Paramedic, or EMT community and would like to be considered a candidate for the Back 41 Pilot program, please complete the form below. In 2025 we hope to get the first 2-3 pilots through the program and Back In Service. Our training is available at no cost to the agency or pilot.

Back41 Pilot Candidate Application

"*" indicates required fields

First Name*

Last Name*

Personal Email*

Work Email*

Location*

Position/Agency*

Date of injury*

Brief description of Injury*

Time left to rehab*

Workers Comp Contact:

How soon could you begin training?*

Are there any ADD accommodations we should know about?