Sierra Ambulance Service, Inc.
An Equal Opportunity Employer
Employment Application
Name
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First Name
Middle Name
Last Name
Email
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example@example.com
Phone Number
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Present Address
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Street Address
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State
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Employment Desired
Position
*
Select One
EMT
Paramedic
Available For
*
Full-Time (48 hours/ week)
Part-Time (34 hours/ week)
Per-Diem
How did you hear about our company and this job opening?
*
Have you ever applied or worked for Sierra Ambulance before?
*
Yes
No
If Yes, When?
Why are you applying for work at Sierra Ambulance?
*
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age)
*
Yes
No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
*
Yes
No
If no, describe the functions that cannot be performed
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)
We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create conflicts of interest.
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Education, Training, and Experience
Schools, College/University, Vocational/Business, Training, etc.
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Employment History
List below all present and past employment starting with your most recent employer (last five years is sufficient). You must complete this section even if attaching a resume.
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Please enter at least 3 references
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Uploads
Please upload the requested certifications, documents or licenses.
State EMT Card
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State Paramedic Card
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CCEMSA EMT Card
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CCEMSA Paramedic Card
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CPR Card
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ACLS Card
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Drivers License
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Medical Exam Report (MCSA-5876)
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Ambulance Drivers Certificate
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Resume
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Please Sign and Date
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I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer’s service, whenever it is discovered. I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information. The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law. This application is current for only 6 months. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer. I understand it is this company’s policy not to refuse to hire a qualified individual with a disability because of that’s person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
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