Job Application Contact Details All fields containing a red asterisk (*) are required fields. Frist Name Middle Name Last Name Social Security Number Date Of Birth Street Address City State Zip Code Phone Number Email Address Job Related Information Desired Position EMT-BasicAdvanced EMTParamedic Full or Part Time Part TimeFull TimeBoth Desired Hourly Rate? Are you legally eligible for employment in the United States? YesNo Legal Information Have you ever been convicted of, pled guilty to, or entered into a pre-trial agreement or similar program with respect to a felony or misdemeanour other than a minor traffic offence?* YesNo If the answer was yes please provide more information (A conviction will not necessarily automatically disqualify you for employment. Rather such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.) Have you been ever been accused of sexual harassment? * YesNo References Reference One Name Phone Number Email Reference Two Name Phone Number Email Reference Three Name Phone Number Email Reference Four Name Phone Number Email Previous Employers Employer One Company Name Phone Number Email Company Address Employer Two Company Name Phone Number Email Company Address Employer Three Company Name Phone Number Email Company Address Employer Four Company Name Phone Number Email Company Address Resume Upload File Types: pdf|doc|docx|txt Other Files Upload File Types: pdf|doc|docx|png|jpg ❌ ❌ With every application, the following items must to be included: Current state Certification or license Current CPR card Valid Driver’s License Any other Certifications pertaining to EMS Terms and Conditions BACKGROUND CHECK: I understand that the Fountain County Ambulance Service will run a criminal background check on me. I also understand that I must be in good physical condition to be a member of this department. Not having any condition that would impair me or my action in the event of an emergency with this department. I hereby authorize Fountain County Ambulance Service to obtain any records pertaining to myself for the benefit of establishing and meeting the requirements of this department. I understand that the information in this application will not be available to other agencies or private individuals. APPLICANT’S CERTIFICATION AND AGREEMENT: I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Fountain County to verify their accuracy and obtain reference information on my work performance. I hereby release Fountain County from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision, based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the employer. However, I further understand that neither the policies, rules, or regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the employer may terminate my employment at any time with or without notice or cause. I agree to the Terms and Conditions. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
