Online Application

 

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

 

Basic Information


Position Applied For
EMT-BasicEMT-Paramedic

How did you learn about us?
AdvertisementEmployment AgencyFriendRelativeInquiryOther

If Other please explain:


Your Name:

Your Address:

Telephone Number:

What is the best time to contact you?:

If you are under 18 years of age, can you provide required proof of eligibility to work?
YesNo

Have you ever filed an application with us before?
YesNo

If Yes, give date:

Have you ever been employed with us before?
YesNo

If Yes, give date:

Do any of your friends or relatives, other than your spouse, work here?
YesNo

If Yes, state name, relationship and location:

Are you currently employed?
YesNo

May we contact your present employer?
YesNo

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.
YesNo

Date available for work:
- or - Available Immediately

What is your desired salary range?

Are you available to work?
Full TimePart TimeTemporary

If available for full time select shift desired:
AnyA ShiftB ShiftC Shift

Are you currently on "lay-off" status and subject to recall?
YesNo

Can you travel if a job requires it?
YesNo


Education


School Name and Address of School Course of Study Years
Completed
Diploma / Degree
High School
Undergraduate College
Graduate / Professional
Other / Specify:


Work Experience



Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.




Job One
Employer
Address
Telephone Number(s)
Starting/Present Job Title
Supervisor
Reason for Leaving
Dates Employed
From

To

Hourly Rate / Salary
Starting

Final

Work Performed
May we contact? YesNo



Job Two
Employer
Address
Telephone Number(s)
Starting/Present Job Title
Supervisor
Reason for Leaving
Dates Employed
From

To

Hourly Rate / Salary
Starting

Final

Work Performed
May we contact? YesNo



Job Three
Employer
Address
Telephone Number(s)
Starting/Present Job Title
Supervisor
Reason for Leaving
Dates Employed
From

To

Hourly Rate / Salary
Starting

Final

Work Performed
May we contact? YesNo



Job Four
Employer
Address
Telephone Number(s)
Starting/Present Job Title
Supervisor
Reason for Leaving
Dates Employed
From

To

Hourly Rate / Salary
Starting

Final

Work Performed
May we contact? YesNo


Comments: Include explanation of any gaps in employment.

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.


Additional Information


Other qualifications:


Specialized Skills

(Skills / Equipment Operated)


TerminalPC/MACTypewriterSpreadsheetWord ProcessingShorthand

Production / Mobile Machinery (list)

Other (list)


State any additional information you feel may be helpful to us in considering your application:

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner; with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.
YesNo


Personal / Professional References

Do no include family members or past supervisors.

Name Phone Number Best Time to Call Occupation


Applicants Statement


I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be neccessary in arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by an written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I AgreeI Do Not Agree


Digital Signature


Please type your name to sign application.


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