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.

    Please enter the following captcha:

    captcha