Position Applied For Basic AEMT Paramedic
Physical Address *
Phone Number *
If yes, give date of application (00/00/0000) - (00/00/0000)
Leaving in you
If yes, give dates of employment (00/00/0000) - (00/00/0000)
Dates available for work
What is your desired salary range?
For full-time please indicate 1, 2, 3 shifts
For part-time please indicate mornings, afternoon, or evenings
For temporary please indicate dates available (00/00/0000) - (00/00/0000)
Elementary School - Years Completed
High School - Years Completed
Undergraduate - Course of Study, Years Completed, Diploma Degree
Graduate Professional - Course of Study, Years Completed, Diploma Degree
Other (specify)
Describe any specialized training, apprenticeship, skills, and extra-curricular activities.
Describe any job-related training received in the United States Military.
1. Employer
Phone Number
Job Title and Supervisor
Reason for Leaving
Dates Employed (00/00/0000) - (00/00/0000)
Hourly Rate/Salary (starting-final)
Work Performed
2. Employer
Address
Phone Number
Job Title and Supervisor
Reason for Leaving
Dates Employed
Hourly Rate/Salary (starting-final)
Work Performed
3. Employer
Address
Phone Number
Job Title and Supervisor
Reason for Leaving
Dates Employed
Hourly Rate/Salary (starting-final)
Work Performed
List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:
Other Qualifications: Summarize special job related skills and qualifications acquired from employment or other experience.
Production/Mobile Machinery (list)
Other
State any additional information you feel may be helpful to us in considering your application.
1. Reference - First and Last Name *
Phone Number *
2. Reference - First and Last Name *
Phone Number *
3. Reference - First and Last Name *
Phone Number *
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 necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. 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 any 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. (Type Full Name in Box) *
