Employment Application Form:
Personal Information:
Full Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Are you legally eligible for employment in the U.S.? (Proof of U.S. citizenship or immigration status is required if hired)?
*
Yes
No
Do you have your North Carolina EMT-B, AEMT, EMT-P certification?
*
Yes
No
What is your state ID/P#
*
Employment Desired:
Position Applying For
*
Please Select
EMT - Basic
Advanced EMT
EMT - Paramedic
Rapid Response Paramedic (RRP)
Dispatcher
Date You Can Start
-
Month
-
Day
Year
Date
Employment Type
*
Please Select
Full-Time
Part-Time
Type of Shift
*
Please Select
Days
Nights
Please choose your preferred office locations
Raleigh, NC (Wake County)
Henderson, NC (Vance County)
Goldsboro, NC (Wayne County)
Lenoir, NC (Caldwell County)
Have You Applied Here Before?
Yes
No
Have You Worked Here Before?
Yes
No
Education:
High School
*
Name of High School Attended
Graduated?
*
Yes
College
Name of College/University Attended
Graduated?
Yes
Number of Years Attended
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Graduated?
Yes
Number of Years Attended
Area of Study/Degree
Skills/Qualifications:
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Reason for Leaving?
Start Date
-
Month
-
Day
Year
Date
May We Contact?
Yes
No
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Reason for Leaving?
May We Contact?
Yes
No
Previous Employer
Name of Previous Employer
Position
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Reason for Leaving?
May We Contact?
Yes
No
References:
Reference 1
Name of Reference
Relationship
Phone
Email
Reference 2
Name of Reference
Relationship
Phone
Email
Reference 3
Name of Reference
Relationship
Phone
Email
Cover Letter & Resume (Optional):
Cover Letter
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Choose a file
Cancel
of
Resume
Upload a File
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Choose a file
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of
Send Application:
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
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