Civilian Paramedic Job Application

Job Application
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Which is the best way to contact you? *

What position are you applying for?*
Do you have an Indiana Paramedic license?*
Do you have your ACLS?*
Do you have your PALS?*
Do you have your BLS?*

Do you have a drivers license?*
How many years of relevant experience do you have?*

Are you willing to undergo a background check, in accordance with local law/regulations?*
Do you have certifications, resume or cover letter to upload?*
Upload your certifications/resume with this application here. * Please note, failure to submit your required documents may cause a delay in processing your application. Combine files if you can. Include first and last name and name of document when naming your files.

Cancelof
Cancelof
Cancelof
Are you a United States Citizen or otherwise authorized to work in the U.S.on an unrestricted basis?*

YesNo
If no, please explain.
Have you ever been arrested for or convicted for a crime that has not been expunged by a court?*

YesNo
If position you are applying for requires you to be 21 years of age or older, are you?*

YesNoNot applicable
Have you applied with Washington Township before?*

YesNo
If yes, when?
Have you worked for for Washington Township under a different name(s) listed on this application? If yes, list names and dates below.*
If applicable, list names of those you are acquainted with or related to who are employed with Washington Township.*

Education

Complete your applicable education below.*

	Name of School	Location	Graduated Y/N	Major Field of Study
High School
College/University
College/University
Trade, Business or Correspondence School

Employment Experience
Do you have current employment or history to provide?*
Firm Name*
Firm Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Position held*
Supervisor*
Describe your job duties.*
Why did you leave?*
Do you have another firm to add?

YesNo
Firm Name
Firm Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Supervisor
Describe your job duties.
Why did you leave?
Do you have another firm to add?

YesNo
Firm Name
Firm Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Supervisor
Describe your job duties.
Why did you leave?
Do you have another firm to add?

YesNo
Firm Name
Firm Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Supervisor
Describe your job duties.
Why did you leave?

Employment Experience cont.
If you held more than one job, which one did you like the most and why? If one job, what did you like about that one? Enter NA if no job.*
Have you ever been discharged or requested to resign from a job? If so, please explain.*
State any additional information you think would be of interest to us in considering your application, including skills below.

Provide 3 references and their contact information. List at least 1 supervisor.*

	Name	Relationship	Phone Number	Email
Reference 1
Reference 2
Reference 3

APPLICANT’S STATEMENT (please read carefully before signing)

   I certify that the information contained in this application is true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interviews may result in immediate discharge whenever it is discovered.

   I authorize the release of any and all information concerning my previous employment and education and any pertinent information that my previous employers or schools may have and release all parties from all liability for any damage that may result from providing the information to the Company.

I authorize my references listed on this application to be checked before employment and understand that this in no way means that I have been promised a position with the Company.

I understand that statements which may be contained in policies, handbooks, practices and other materials do not create any contract, expressed or implied, or guarantee of employment. I understand that the Company has the unconditional and absolute right to modify, amend or terminate policies, practices, benefit plans and other Company programs as it sees fit.

   In consideration of my employment, I agree to conform to the rules, regulations and policies of the Company and agree that my employment and compensation may be terminated at any time, either by me or by the Company, with or without cause.

We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, height, weight, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications.

I have read and understand the foregoing six paragraphs and have voluntarily agreed to them by signing below.
Signature*

Clear
Please verify that you are human*

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