Start with your present or most recent employer. 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 statuses.

I give consent for my driver’s license to be verified to be valid as well as permission to check my entire driver’s abstract including driving history, violations, suspensions, or infractions, noted by the Department of Motor Vehicles. This driving history will be taken into consideration when considering employment opportunities. Upon employment, your license will be registered under the NYS DMV LENS program, which would notify a designated manager at Assist Ambulance whenever you receive a moving violation, your license is suspended, or revoked, or any other derogatory event on your license.

In accordance with all applicable statutes and laws, I hereby give my written consent to Assist Ambulance to contact any and all of my employer(s) or former employer(s) for any and all records relating to me while I was employed by that company. This includes all written documents that are part of my employee file and anything that is known and is not in the file. This can be transferred by mail, electronically, or by oral report. I acknowledge by this authorization that I such company from any obligation and liability in the disclosure of the contents of such files and the professional observations or opinions contained therein.