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

    Full or Part Time

    Desired Hourly Rate?

    Are you legally eligible for employment in the United States?

    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?*

    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? *

    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.


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