Taylor County EMS Employment Application

Taylor County EMS

Application for Employment
Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.
Today's Date*

MonthDayYear
Date
Last name*
First Name*
Middle Name*
Street Address*
City*
State*
ZIP*
Email address*
example@example.com
Cell Phone #*
Texas DSHS EMS #*
Position applied for:*
How did you hear of this opening?*
When can you start employment?*

MonthDayYear
Date
Desired Wage*
What type of employment are you seeking?*
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation)*
Have you ever been convicted, placed on probation or given deferred adjudication for any crime?*
If YES, please provide details of your criminal history.
Have you ever been involuntarily terminated from a position of employment?*
If YES, please explain your termination(s).
EDUCATION
High School Name, Location, & Graduation Date:*
College Name, Location, & Graduation Date:
Other Training Name, Location, & Graduation Date:
Please list any other pertinent education, training, certifications, experiences, etc. you feel we should consider.
EMPLOYMENT HISTORY

(Start with most recent employer)
Company Name #1
Address
Telephone
Date Started

MonthDayYear
Date
Starting Wage
Starting Position
Date Ended

MonthDayYear
Date
Ending Wage
Ending Position
Name of Supervisor
Reason for leaving
Company Name #2
Address
Telephone
Date Started

MonthDayYear
Date
Starting Wage
Starting Position
Date Ended

MonthDayYear
Date
Ending Wage
Ending Position
Name of Supervisor
Reason for leaving
Company Name #3
Address
Telephone
Date Started

MonthDayYear
Date
Starting Wage
Starting Position
Date Ended

MonthDayYear
Date
Ending Wage
Ending Position
Name of Supervisor
Reason for leaving
REFERENCES
Reference #1 Name
Reference #1 Telephone #
Reference #1 Relationship to You
Reference #2 Name
Reference #2 Telephone #
Reference #2 Relationship to You
Reference #3 Name
Reference #3 Telephone #
Reference #3 Relationship to You
Please upload a copy of your resume here (must be in PDF format):*

Cancelof
By my signature indicated below, I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. Also by my signature below, I authorize Taylor County EMS to make any investigations of my background, to include but limited to, prior educational and employment history, professional credentials, and driving record. I understand that employment at Taylor County EMS is "at will," which means that either I or Taylor County EMS can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.
Signature*

Clear
Signature Date*

MonthDayYear
Date
Should be Empty: