Application Form

Application Form
Thankyou for your interest in working for Phoenix Emergency Medical Services. In order to start with your on boarding with us, all questions need to be answered in full. Once complete our HR team will get in contact you to arrange a friendly introduction where we tell you more about who we are and you have the chance to ask any questions. If both parties are happy moving foward then we will be requesting proof of Qualifications, Identification and DBS, proof of address for compliance. As well as this some declarations. Thankyou for taking the time to do this and we look foward to having you on the team.
When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.
Personal Information
Name:*

First NameLast Name
Date of Birth:*
MaleFemaileOtherPrefer not to say
Address:*

Street Address

Street Address Line 2

CityCourtly

Post Code
Email Address:*
Phone Number:*

Area CodePhone Number
Next of Kin:
Next of Kin phone number:

Area CodePhone Number
National Insurance Number:*
YESNO
If Yes, please upload a picture

Cancelof
Take Photo
Driving Information
YESNO
Driving Licence Number:
YESNOProvide Myself
DVLA Code

Cancelof
YESNO
If yes, to the above question please state Code and Points:
Please take a picture of the front of your licence. This will also be used for ID check.
Please take a picture of the back of your licence
Pre-Hospital Qualifications
First Responder / CFRFREC 3 / 4ECA (inc Blue Lights)FREC 5 / AAP / TechParamedicNurseDoctorNeed training, please
Please Upload your qualification to match set roll above:

Cancelof
Take Photo
YESNONeed one please, there will be a cost of £75 to apply for one.
If your on the update services, please state number if consent to Phoenix EMS checking your DBS on the update service?
If yes, please upload or take a picture.

Cancelof
Take Photo
What is your previous experience in the Pre hospital field?*
Reference's

Phoenix EMS requires two references for your application, with at least one being a work or college reference, and the other can be a character reference. The character reference must have known you for a minimum of three years. By providing us with the details of your two references, you agree that Phoenix EMS may contact them.
Reference 1
Name*

First NameLast Name
Job Title *
Phone Number

Area CodePhone Number
Email*
example@example.com
How do you know of this person?*
Reference 2
Name*

First NameLast Name
Job Title *
Phone Number

Area CodePhone Number
Email*
example@example.com
How do you know of this person?*
Lifting twelve stone between two peopleLifting patientsCarry chairStair climberStanding for long periods of timeGetting on and off the floorDrivingLifting equipmentStretcherWalkingManual HandlingI can NOT do all of the above.
General Information
YESNO
YESNOOther
YESNO
Heart disease including HypertensionLung disease including CODP / Asthma / long COVIDRecurrent kidney or blood disorderME / CFF or a post viral fatigue syndromeRecurrent back / joint / muscle pain requiring more then over the counter medicationFits / blackouts / locDiabetesSkin diseaseVisual problems or eye diseaseMirgraines or sever headachesDepression, anxiety or other MH issues (remember you are protected under the disability act)Alcohol / drug misuse or dependancy including legal highs.Difficulty in standing or bending, lifting, twisting other movementsChest pain/ angina or previous heart attacksFibromyalgiaTia / strokeArthritisCancerNone of the above
Any other condition you believe Phoenix EMS needs to be aware of.
Hep A, B and CCOVIDTBTetanusMMR
Do you take any regular medication that can cause a risk to yourself, staff or patients that cause fatigue, drowsiness or specifies the need for caution when driving or operating heavy machinery.
Applicants are advised that any false or misleading answers or failure to give pertinent information may render the individual liable to disciplinary action which may include dismissal. The purpose of the health screening is to ensure that new staff do not have a health problem or disability that might impair their ability to carry out tasks required in the post. Any necessary adjustment can be made to ensure new staff who do have a health problem or disability to carry out their job safely and any need for ongoing health surveillance can be identified. I certify that the information I have given is true to the best of my knowledge. I agree to notify Phoenix EMS of any change in my health which may affect my ability to undertake my job safely.I understand that if any recommendations are necessary as a result of this assessment, Phoenix EMS will discuss the recommendations with me. By typing "YOUR NAME" in the box below this is confirmation of an electronic signature.*
Date*

MonthDayYear
Date
Signature*

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Where did you hear about us at Phoenix EMS?*
Thank you for taking your time to fill out this application form looking to at Phoenix EMS. Someone from the HR team will be in touch soon.
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Application Form

Personal Information

Driving Information

Pre-Hospital Qualifications

Reference's

Reference 1

Reference 2

General Information