Application Form

Full Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

If you are under the age of 18 years old, do you have a work permit?*

If hired, can you submit verification of your legal right to work in the US?

Position Applying For*

Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations, in a safe and efficient manner?

If applying for EMT and/or RN, are you certified in California with EMSA and San Diego County registered for EMTs?*

Date You Can Start*

MonthDayYear

Salary Desired

Have You Worked Here Before?

YesNo

Have You Applied Here Before?

YesNo

High School

Name of High School Attended

Number of Years Attended

Graduated?

Yes

College

Name of College/University Attended

Number of Years Attended

Graduated?

Yes

Area of Study/Degree

Graduate School

Name of Graduate School Attended

Number of Years Attended

Graduated?

Yes

Area of Study/Degree

Trade School/Other

Name of Trade/Technical/Other School Attended

Number of Years Attended

Graduated?

Yes

Area of Study/Degree

Skills

List any relevant skills

Qualifications

List any relevant certifications or qualifications

Current Employer*

Name of Current Employer or NONE if not Employed

Position*

Start Date*

MonthDayYear

May We Contact?*

YesNo

Comments:

Previous Employer

Name of Previous Employer

Position

Start Date

MonthDayYear

End Date

MonthDayYear

Reason for Leaving?

Previous Employer

Name of Previous Employer

Position

Start Date

MonthDayYear

End Date

MonthDayYear

Reason for Leaving?

Reference 1*

Name of Reference

Relationship*

Years Acquainted*

Phone*

Email

Reference 2*

Name of Reference

Relationship*

Years Acquainted*

Phone*

Email

Reference 3*

Name of Reference

Relationship*

Years Acquainted*

Phone*

Email

Cover Letter

How did you hear about us?*

Resume

CONSENT TO BACKGROUND INVESTIGATION

It is First Aid Services intent to keep all information we receive during any background investigation private and confidential. Please read and sign the statement below allowing us to verify past employment and all information given on this application.

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By clicking the submit button below, I certify that answers given in this application are true and complete to the best of my knowledge. I understand that any false statements on this application could result in my termination from First Aid Services should I be hired. I understand First Aid Services is not obligated to offer the position to me, even after completing this application or following a job interview. I understand that First Aid Services has certain rules and procedures which must be followed. I agree that if I am employed I will follow these rules; if I do not, I will be subject to disciplinary action that could include dismissal. I understand that First Aid Services is an “at-will” employer, which means that either First Aid Services or I can terminate the employment relationship at any time for any lawful reason or for no reason at all. No representative of First Aid Services other than its Managing Member has any authority to agree to the contrary. Further, First Aid Services’ Managing Member may not alter the “at-will” nature of the employment relationship unless done so specifically in a written agreement signed by both of us. I understand if First Aid Services hires me, my employment is conditioned on my ability to provide proof of work authorization and identity as required by federal law and the completion of any other post-employment requirements.

Signature

Clear

Employment Application:

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):