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New Town Ambulance Service Application for Employment



Personal

First Name: *
Last Name: *
Middle Name:
Address: *
City: *
State: *
Zip: *
Application Date: *
Home Telephone: *
Cell Number:
Email Address: *

Employment Desired

Position Desired: *
If Other, please specify position applying for:
Start Date: *
Full Time or Part Time: *
Have you ever been convicted of a felony? *
If yes, please explain and provide date of conviction:

Education History


High School

High School, Address, City, State: *
Year completed: *
Graduate: *

College

College, Address, City, State:
Year completed:
Graduate:
Subjects Studied:

Graduate/Professional School

Graduate/Professional School, Address, City, State:
Year completed:
Graduate:
Subjects Studied:

Military

Have you or are you serving in the U.S. Armed Services?
If yes, which branch?
Describe any relevant experience or training.

Employment History

Employer #1: *
Most recent 1st
Dates From: *
Dates To: *   
Address: *
City: *
State: *
Zip: *
Phone: *
Job Title: *
Salary: *
Supervisor: *
Reason for Leaving: *

 

Employer #2:
Dates From:
Dates To:    
Address:
City:
State:
Zip:
Phone:
Job Title:
Salary:
Supervisor:
Reason for Leaving:

 

Employer #3:
Dates From:
Dates To:    
Address:
City:
State:
Zip:
Phone:
Job Title:
Salary:
Supervisor:
Reason for Leaving:

 

Employer #4:
Dates From:
Dates To:    
Address:
City:
State:
Zip:
Phone:
Job Title:
Salary:
Supervisor:
Reason for Leaving:

 


References


Reference #1

Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
Occupation: *
Number of years known: *

Reference #2

Name:
Address:
City:
State:
Zip:
Phone:
Occupation:
Number of years known:

Reference #3

Name:
Address:
City:
State:
Zip:
Phone:
Occupation:
Number of years known:
Please read and understand this statement before signing your application: *
The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected, or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the employer to contact and obtain information about me from previous employers, educational institutions and "references" I provided and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume, or a personal interview. To assist in the processing of my Application, I waive all lefts and claims I may otherwise have against the employer or its representatives, for seeking and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose. I fully understand and accept all terms and conditions in the above statement.

This application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

New Town Ambulance reserves the right to keep applications current for longer than 30 days without notifying me, as deemed necessary by administration. This application is not an employment agreement. If I accept an offer of employment I understand the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

I fully understand and accept all terms and conditions in the above statement.