INDEPENDENCE FIRST AID SQUAD
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Application for Employment
READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THIS APPLICATION.
This application must be completed by the applicant. Any misstatement of fact, omissions or attempt to mislead this agency, if deliberate or in error, may lead to your disqualification at any time. This electronic application must be completed in its entirety. If any requested data does not apply to you, chose "N/A". All questions must be answered completely.
*
Indicates required field
Position Applying For:
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Per Diem EMT
Part Time EMT
Full Time EMT
Availabilty (Select all that apply):
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Weekdays (6a-6p)
Weeknights (6p-6a)
Weekend Days (6a-6p)
Weekend Nights (6p-6a)
Personal Information
Applicant Name
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First
Last
Applicant Address
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Line 1
Line 2
City
State
Zip Code
Country
Applicant Email
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Applicant Phone
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Applicant Drivers License State
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Applicant Drivers License Number
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Are you over the age of 18?
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Yes
No
Note:
If under 18, hire is subject to verification that you are of minimum legal age.
If hired, can you present evidence of your identity and legal right to work in this country?
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Yes
NO
Employment History
Current Employeer Name & Address
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Line 1
Line 2
City
State
Zip Code
Country
Supervisor's Name
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Supervisor's Phone Number
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May we contact your supervisor?
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Yes
No
Previous Employment:
List up to 2 recent places of employment, from most recent to first. Include name of organization/company, dates of employment, and reason for leaving. Please provide name, address, and phone number.
Previous Employer 1
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Affiliations:
Have you been, or are you a current member of any other Emergency Services Department (EMS, Rescue, Fire or Law), paid or volunteer?
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No
Yes
Previous Employer 2
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If "Yes", please list all associated organizations with name and dates of membership/employment
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Education
List school(s), address, years attended, degree or certification received
Education (High School)
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High School Area of Study
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Education (College or Trade)
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College or Trade area of study
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Are you a United States Citizen or alien authorized to work in the United States?
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Yes
No
References
Reference #1 Name
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First
Last
Reference #1 Relationship
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Reference #1 Phone Number
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Reference #2 Name
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First
Last
Reference #2 Relationship
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Reference #2 Phone Number
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Reference #3 Name
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First
Last
Reference #3 Relationship
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Reference #3 Phone Number
*
Attachments
Multiple Documents must be attached as a single file
Please upload a cover sheet and resume if available
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Max file size: 20MB
Please upload electronic images of your certifications. (PDF, JPEG, or PNG files only. PDF is preferred)
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Max file size: 20MB
If you would like to submit any additional information or notes with your application, you can do so here
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Authorization
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed; misstatement of fact, omissions or attempts to mislead the agency, either deliberate or in error, may lead to disqualification or termination at any time.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.
Our agency adheres to a policy of Employment-at-Will which allows either party to terminate the employment relationship at any time, for any reason, with or without cause or notice.
I also understand and agree that no representative of the agency has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized agency representative.
I further authorize a full background check.
Type your name, as a form of Electronic Signature
*
Today's Date
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Submit Application for Employment
Home
About Us
History
News
Agency Statistics
Apparatus
Officers
Our Team
Billing Information
Privacy Policy
Requests
>
Standby Request Form
Join
Volunteer Today!
Employment
Training
Contact Us
Member Area