Assist Ambulance » Applications

Applications

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EMPLOYMENT EXPERIENCE
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.
Employment
Employer
Title
Employed From
Employed Till
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Supervisor
First Middle Last
Telephone
Salary
Brief description of duties
Reason for leaving
May we contact
- Yes
- No
Add more employment Remove
WE ARE AN EQUAL OPPORTUNITY EMPLOYER

SPECIAL QUALIFICATIONS
Below please list any special qualifications that may or may not make you more qualified for the position you are applying for
TELL ABOUT US ABOUT YOU
Below please tell us what would make you an asset to have at Assist Ambulance
I understand that all information filled out on this application must be true and information that is fraudulent or purposely misleading can be grounds for disqualification from employment or termination if found out about after being employed.
Print Name
Signature
For Office Use Only
Supervisor
Status
- Hire
- Call Back
- No Hire
Employment Type
- Full Time
- Part Time
- Per Diem
Name
First Last
Signature
WE ARE AN EQUAL OPPORTUNITY EMPLOYER

CONSENT FORM-DISCLOSURE OF INFORMATION
Name
First Name Middle Name Last Name
Social Security #
Date of Birth
Driver License #
State
EMT/P #
Address
Street Address City State / Province / Region ZIP / Postal Code Country
I hereby give consent for a consumer report for employment or tenancy purposes. I hereby authorize, without reservation, any law enforcement agency, administrator, state agency, state repository, former employer, corporation, credit agency, educational institution, city, state, federal court, military institution, information service bureau, employer or insurance company to furnish any and all information.

I do understand the investigation will include information from law enforcement agencies, state agencies and public records information, such as credit, social security, criminal, motor vehicle and workers compensation in accordance with the American with Disabilities Act. This report will include information as to my character work habits, performance and experience, along with the reasons for termination of past employment from previous employers. This releases the aforesaid parties from any liability and responsibility for collecting the above information at any time.

According to the Fair Credit Reporting Act (Law 91-508) SS 606:
A person may not procure or cause to be prepared an investigative consumer report on any consumer unless it is clearly and accurately disclosed to the consumers that an investigative consumer report including information as to his character, general reputation, personal characteristics and mode of living and employment history, whichever are applicable, may be made. I also understand that if I am denied employment because of the consumer investigation, it is my right to have the name of the agency or agencies disclosed to me within the time allowed. This authorization, in original or copy form, shall be valid for this and any further reports or updates that may be requested.
Name
First Name Middle Name Last Name
Signature