Application for Employment

Name
Address
City State ZIP
Email
Telephone Social Security #
Certification Level      State      Certification #

Employement Desired
Position Full-Time Part-Time
Volunteer
Date You Can Start:
Salary Desired:
Are you currently Employed? Yes No May we contact current previous employers? Yes No

Education
Highest Grade Level completed:      Do you have Medical Command in the EHSF? Yes No
School
Name/Location
Major
Degree/License/Certificate
Cert #
Year Graduated
High School

College

EMS
List any professional Designations:
List other skills or qualifications:

General
Have you ever volunteered for an EMS ? Yes No If so, Where & When?
US Military Service: Where do you volunteer now:

Date
Name & Address
Salary
Position
Reason for Leaving
From:
   To: 
From:
   To: 
From:
   To: 
Which of these jobs did you like best and why?

References: (Give the name of three people not related to you , whom you have konw for at least one year.)
Name
Address
E-Mail
How Acquainted
Years Acquainted

Emergency Contact:
Relation:
Address:
Telephone:
I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered my application may be rejected and, If I am employed, my employment may be terminated at any time. I agree to a criminal background check, driver's information check and pre-employment physical, including drug testing, prior to employment. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminatated with or without cause and without notice. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice at any time by the company.
Today's Date: Digital Signature:

 

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