Employment Application

Employment Application

Jefferson County Emergency Medical Services 581 W. Old AJ Hwy New Market, TN 37820
Full Legal Name*

First NameMiddle NameLast Name
Phone Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Check one

I am looking for Full time workI am Looking for Part time work
Position Applying For
I can speak english:

FluentlyPoorlyNot at all
I am a U.S. Citizen or am authorized to work in th U.S. on an unrestricted basis:

YesNo
Have you ever been convicted of a felony? (This does not automatically exclude you from employment )

YesNo
Do you have reliable transportation?

YesNo

State All the Hours you are Available to work in the chart below.

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
From:
To:

Education History
High School
High School Name
High School City, State
Years Attended
Graduated

YesNo
College
College Name
Years Attended
Focus of Study
Graduated

YesNo
Other Education
Other education:
Employment History
Most Recent Employer
Most Recent Employer Name
Dates of Employment

Date Started Date Ended

Dates worked for
Most Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary
Type of work perfomed
Reason for Leaving
Supervisors Name and Position
Second Most Recent Employer
Second Most Recent Employer Name
Dates of Employment

Date Started Date Ended

Dates worked for
Second Most Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary
Type of work perfomed
Reason for Leaving
Supervisors Name and Position
At this point in the application you are free to tell us what makes you the perfect candidate for Jefferson County EMS, if you desire.
Hobbies, interest? (not required )
Feel Free to upload your Resume

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What TN EMS Licensure Level do you hold
TN EMS Licensure Number
TN License Expiration

MonthDayYear
Date
Upload Your TN EMS License

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TN DL Number
TN DL Expiration

MonthDayYear
Date
Upload your TN Drivers License

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BLS Expiration

MonthDayYear
Date
Upload your BLS Certification

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By Submitting this application:

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Thank you for taking time to complete this job application. We will be in contact with you shortly. We look forward to you potentially becoming part of the JCEMS family. If you should have any questions please contact us at the following.

Buisness Hours M-F 8am-4pm

By Phone: 865-471-9001

or by Emailing:

rsatterfield@jeffersoncountytn.gov

bphillips@jeffersoncountytn.gov
Should be Empty:

Employment Application

Education History

High School

College

Other Education

Employment History

Most Recent Employer

Second Most Recent Employer