Career Application

Career Employment Application

READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THIS APPLICATION.

This application must be completed by the applicant. Any misstatement of fact, omissions or attempt to mislead this agency, if deliberate or in error, may lead to your disqualification at any time. This electronic application must be completed in its entirety. If any requested data does not apply to you, chose "N/A". All questions must be answered completely.

To apply for a career position you must be a certified EMT including but not limited to: NJEMT (preferred), NREMT (preferred), PAEMT

Personal Information

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Position Applying For: *

Full Time EMT - Day Shift Full Time EMT - Night Shift Part Time EMT - Day Shift Part Time EMT - Night Shift

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

Social Security Number *

Drivers License State & Number *

certifications

Please upload electronic images of your certifications.
(PDF, JPEG, or PNG files only. PDF is preferred)

BLS CPR Provider *

CPR Expiration Date *

CPR Certification *

Max file size: 20MB

EMT (State/National) *

EMT Expiration Date *

EMT Certification *

Max file size: 20MB

CEVO/EVOC *

CEVO/EVOC Completion Date *

CEVO Certification *

Max file size: 20MB

IS-100 *

IS-100 Completion Date *

ICS-100 Certification *

Max file size: 20MB

IS-200 *

IS-200 Completion Date *

IS-200 Certification *

Max file size: 20MB

IS-200 *

IS-200 Completion Date *

IS-200 Certification *

Max file size: 20MB

Additional certifications can be uploaded here *

Max file size: 20MB

Multiple Documents must be attached as a single file

References

Reference 1 Name *

Reference 1 Address *

Reference 1 Phone *

Reference 2 Name *

Reference 2 Address *

Reference 2 Phone *

Reference 3 Name *

Reference 3 Address *

Reference 3 Phone *

Attachments

Please upload a cover sheet and resume if available *

Max file size: 20MB

If you would like to submit any additional information or notes with your application, you can do so here *

authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed; misstatement of fact, omissions or attempts to mislead the agency, either deliberate or in error, may lead to disqualification or termination at any time.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

Our agency adheres to a policy of Employment-at-Will which allows either party to terminate the employment relationship at any time, for any reason, with or without cause or notice.

I also understand and agree that no representative of the agency has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized agency representative.

I further authorize a full background check.

Type your name, as a form of Electronic Signature *

Date *

Submit Application