Primary Care Paramedic Employment Application Form

Primary Care Paramedic - Employment Application
Instructions

Please complete all sections as thoroughly as possible and be prepared to include the documents requested in Section 7 if invited to attend pre-employment testing. It is necessary to provide complete information as this will be used to determine eligibility and qualifications for employment. A separate application is required for each competition. Along with your application, please be sure to attach a copy of your cover letter and resume. The personal information requested on this form is collected and managed as per the Municipal Freedom of Information and Protection of Privacy Act, R. S.O. 1990. All information provided to us is considered supplied in confidence.

Section 2: Personal Information
Name*

First NameLast Name
Address*
Street Address
Mailing Address, if different
*
City
*
Province
Postal Code*
ex: A1B 2C3
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Have you ever been convicted of a Criminal Offence for which you have NOT received a pardon and that prohibits you from working under the position you are applying for?*

YesNo
Are you legally allowed to work in Canada?*

YesNo

Section 3: Education, Training, and Professional Associations

Please provide details of secondary and post-secondary education, courses, and training that have given you work-related knowledge, skills, and/or abilities starting with the highest level achieved. Attach an additional page if necessary. Please note: Offers of employment are conditional upon providing proof of education noted below.

	Area of Study/Course	Duration mm/yy to mm/yy	Completed
Name of Institution or Organization
Name of Institution or Organization
Name of Institution or Organization

Section 4: Employment History
Have you previously worked for the KDSB?*

YesNo
Are you Base Hospital Certified in the Northwest Region?*

YesNo
When did you previously work for the KDSB?*
Enter month and year, ex: December 2020

Section 5: ADDITIONAL INFORMATION
Please describe any other information which might help us evaluate your candidacy (summarize why you believe you qualify for the position(s) for which you have applied):*

Section 6: References

Reference checks will be conducted to assess your past work performance. We ask for this information in advance to expedite the recruitment process later on. By signing this section, you understand that a condition of your employment is verification of past employment, education, and other information provided by you. Accordingly, by signing below, you give a representative of the Kenora District Services Board permission to obtain or exchange personal information with the persons listed below for the purposes of employment with the Kenora District Services Board.

Please list three (3) professional, employment-related references, preferably those in a supervisory role. Please do not include the names of relatives or friends.*

	Name & position:	Relationship (i.e. manager):	No. of Years Known:	Email Address (preferred):	Telephone Number:
Reference 1
Reference 2
Reference 3

I confirm that, to the best of my knowledge, the information presented on my resume, application, or verbally is complete and accurate. I understand that a false statement with the intent to mislead Kenora District Services Board may disqualify me from employment or be grounds for dismissal.
*

Clear
Date

DayMonthYear
Date

Section 7: Proof of Qualifications
As part of your Application for Paramedic Employment with Kenora District Services Board – Northwest Emergency Medical Services, you must be prepared and able to provide copies of the following documents if invited to participate in pre-employment testing. Please check all those that you WILL BE ABLE to provide at a later date (please DO NOT provide with your application):

College Diploma or a letter from the College confirming your Graduation DateAEMCA Certificate or letter of registration to write AEMCA testingIf AEMCA pending, copy of valid First Aid Certificate must be providedCurrent CPR-BLS Provider Certification (Must meet the Canadian Heart & Stroke Foundation Guidelines)Valid Ontario Class F Driver's License (front and back)Proof of eligibility to work in CanadaDriver’s Abstract – 3 year search issued within the last 60 daysCriminal Record Check including Vulnerable Sector Screening (issued within the last 90 days) A passport quality photoAn immunization/communicable disease serology report providing (refer to sample documents and the Ambulance Service Communicable Disease Standards attached to the PCP Recruitment Overview found on our website) completed Table 1 Part A signed by a physician and proof of immunization and/or serologic testing as applicable (refer to Table 1, Part A)

Section 8: Upload your cover letter and resume

Please upload your cover letter and resume in PDF format.
File Upload

Cancelof

Section 9: Agreement

Please read carefully before signing. This application is not valid unless your name, as authorization, is signed in the “signature” space provided below. (Note: If this application is submitted electronically, typing your name is deemed equivalent to signing).I certify that the information provided in this application and any attachments to it are true and complete. I understand that any false statements or deliberate omissions made by me on this application or attachments may be sufficient cause for the cancellation of the application and, if I have been employed, for the immediate dismissal from the Kenora District Services Board.
Signature

Clear
Date

DayMonthYear
Date
Please verify that you are human*
Should be Empty:

Primary Care Paramedic - Employment Application

Instructions

Section 1: Position Information

Section 2: Personal Information

Section 3: Education, Training, and Professional Associations

Section 4: Employment History

Section 5: ADDITIONAL INFORMATION

Section 6: References

Section 7: Proof of Qualifications

Section 8: Upload your cover letter and resume

Section 9: Agreement