Medstar Employment Application

Application for Employment

Medstar Ambulance of Mendocino County Inc. (Medstar) is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, national origin, age, sexual orientation, marital or veteran status, physical or mental disabilities, or any other legally protected status.
Applying for position

EMT

Job description

Personal Information
Full name*

First NameMiddle NameLast Name
Current address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email address*

Confirmation Email
Primary phone*

Area CodePhone Number
Is this a cell phone?*

YesNo
May we text you at this number?

YesNo
Work phone

Area CodePhone Number
May we call you at work?

YesNo
Applying for position
Which of the following are you willing to work?*

Full-TimePart-TimeTemporaryOn-CallNightsSaturdaysSundays
When will you be available to start?*

MonthDayYear
Date
How did you find out about this position?*

EDDSocial mediaMedstar websiteReferred by Medstar employeeOther
Name of referring Medstar employee:

First NameLast Name

Answer Yes or No to each of the following questions:*

	Yes	No
1. Are you at least 18 years of age?
2. Do you have a valid California Driver License?
3. Can you provide proof after you are hired that you can legally work in the United States? If hired, you will be required to submit proof of the legal right to work in the United States.
4. Have you reviewed the job description, including all essential functions, of the job for which you are applying? A link to the job description can be found at top of this application.
5. Can you, with or without accommodation, perform all of the essential functions of the job for which you are applying? We will consider all reasonable accommodations that may be necessary for a qualified applicant to perform the essential functions of the job.

Explain "No" answers above.

Education & Training

List schools attended (high school, college, trade, business or correspondence):

	School name	School location	Graduate?	Subjects studied	Degree
1.
2.
3.

List any training you have received that may help to qualify you for the position for which you are applying (trade, vocational, military, etc.):

	Type of training	Where was it acquired?	Date(s)	Completed successfully?
1.
2.
3.

List any licenses or certificates you have that may help to qualify you for the position for which you are applying:

	License/certificate title	License/certificate number	State of issuance	Expiration date
1.
2.
3.

List any languages you speak or write fluently (please note "speak" or "write" as applicable):

Employment History
Please provide your entire work experience, beginning with your present or most recent job. Show promotions as separate jobs. Be sure to include appropriate military experience. If you need additional space, please supply all requested information in electronic format (Word document, PDF, etc.) and attach in the Other Attachments section below.
Employer 1
Employer's name
Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employed from

MonthDayYear
Employed until

MonthDayYear
Supervisor's name
Your title
Describe duties
Reason for leaving
May we contact this employer?

YesNo
Employer 2
Employer's name
Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employed from

MonthDayYear
Employed until

MonthDayYear
Supervisor's name
Your title
Describe duties
Reason for leaving
May we contact this employer?

YesNo
Employer 3
Employer's name
Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employed from

MonthDayYear
Employed until

MonthDayYear
Supervisor's name
Your title
Describe duties
Reason for leaving
May we contact this employer?

YesNo

References

Provide personal and professional references we may contact.

	Full Name	Address	Phone	Relationship
1.
2.
3.

Required Documents
Upload true and correct copies of the following:
Valid California EMT Certificate*
Valid California Driver License*
Valid California Ambulance Driver Certificate*
Current Medical Examiner's Certificate*
Current CPR Card*
DMV Driver Record Printout*

Other Attachments
Upload your resume, additional employment history, or other relevant documents.

Browse Files

Cancelof

Acknowledgements & Submission

Read and acknowledge each statement by typing your initials in the box:*

	Initials
I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment.
I understand, where permissible under applicable law, I may be subject to a pre-employment drug screening after receiving a conditional offer of employment, and must successfully pass a drug screening before being permitted to commence work with Medstar.
I authorize Medstar and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied, including, but not limited to, my character, general reputation, personal characteristics, or mode of living, and release same from liability resulting from the information released. I authorize employers, schools, and other persons named on this application to provide any information or transcripts requested.
I understand employment with Medstar is contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.
I expressly understand and agree that either Medstar or I may terminate my employment relationship with Medstar at any time, with or without cause or notice.
I understand that no representation, whether oral or written, by any representative or agent of Medstar, at any time, can constitute an implied or expressed contract of employment. I further understand no representative or agent of Medstar has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit, or other terms or conditions of employment other than in a document signed by the President of Medstar or his/her authorized representative.
I certify that all of the above information is true and complete, and I understand that any falsification or material omission of information may result in denial of employment or, if hired, may result in termination regardless of the time lapse before discovery.

MY SIGNATURE BELOW IS EVIDENCE I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.*

Applicant's signature Clear
Date*

MonthDayYear
Applications will be maintained in accordance with applicable laws.
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Application for Employment

Applying for position