Application for Employment

EDUCATIONAL BACKGROUND:

EDUCATIONAL BACKGROUND:

Rows	Name and Address of School	Course of Study	Years Completed	Diploma/Degree
High School
Undergraduate College
Graduate/Professional
Other(Specify)

WORK EXPERIENCE: Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, national origin, disabilities or other protected status.
Employer*
From*
To*
Work performed*
Address*
Telephone Number(s)*
Format: (000) 000-0000.
Starting/Present Job Title*
Starting Pay:*
Final Pay:*
Supervisor*
Reason for Leaving*
May we contact this employer?*
Employer
From
To
Work performed
Address
Telephone Number(s)
Format: (000) 000-0000.
Starting/Present Job Title
Starting:
Final:
Supervisor
Reason for Leaving
May we contact this employer?

THIS ONE IS OPTIONAL: Employer
Dates Employed From To
Work Performed
Address
Telephone Number(s)
Format: (000) 000-0000.
Starting/Present Job Title
Hourly Rate/Salary Starting:
Supervisor
Final:
Reason for Leaving
May we contact this employer?
Describe any specialized training, apprenticeship, skills and extracurricular activities.
Describe any job-related training received in the United States Military.
List professional, trade, business or civic activities and offices held. (You may exclude membership which would reveal protected status.)
Summarize special job-related skills and qualifications acquired from employment/other experiences.
List any other special skills or additional information that you feel would be helpful to us in considering your application.
Have you ever been disciplined or fired?*
If yes, why?

After reading the attached job description, please list any reason known to you why you might be unable to physically and mentally perform the particular job for which you are applying?*
Are you presently using illegal drugs or alcohol?*

PERSONAL REFERENCES: Do not include family members or past supervisors already mentioned in this application.

Rows	Name	Phone No.	Years Known
1.
2.
3.

PROFESSIONAL REFERENCES: Do not include family members or past supervisors already mentioned in this application.

Rows	Name	Phone No.	Years Known
4.
5.
6.

Agreement:
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize you to make such investigations and inquiries of any and all statements contained in this application for employment including criminal background check as may be necessary in arriving at an employment decision.
This application for employment will be considered active for a period of six months. Any application wishing to be considered for employment beyond this time period should inquire as to whether applications are being accepted at that time.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in rejection for employment or subsequent discharge. I understand also that I am required to abide by all policies, rules, and regulations.
Signature of Applicant

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Date

MonthDayYear
Date
I. ____________________________________ understand that successful completion of a pre-employment drug test and pre-employment physical examination will be required for all persons selected for hire. These tests must be completed before starting work with the Parsonsburg Volunteer Fire Company, Inc. I also understand that drug screening tests may be required during the course of employment and refusal to submit to any test will be cause for termination.
Signature of Applicant

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Date

MonthDayYear
Date
Under Maryland law an employer may not require or demand any applicant for employment or any employee to submit to take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer to violate this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.00.
The term applicant for employment or prospective employment or any employee as used in this subtitle does not include a law enforcement officer as defined in §727 of article 27, or any employee or law enforcement agency of the state of Maryland, or any county, incorporated city or town, or other municipal corporation.
Signature of Applicant

Clear
Date

MonthDayYear
Date

Parsonsburg Volunteer Fire Company Inc.
33030 Old Ocean City Rd.
P.O. Box 208
Parsonsburg, Maryland 21849
Ambulance Service Application supplement
Thank you for your interest in employment with the Parsonsburg Volunteer Fire Company Inc. Ambulance Service. In addition to a completed application the following information is required.
- Copy of Driver's License
- Copies of all valid certifications (Paramedic, CPR, ACLS, PALS etc.)
- Certified Copy of your current driving record
- Copy of current EVO
- Copy of high school diploma or GED
If you have any questions please email: employment@parsonsburgfire.com

Copy of Driver's License*

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Copy of valid Paramedic or EMT or CRT License *

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CPR*

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For ALS upload ACLS, PALS

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Copy of EVO *

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Should be Empty:

Application for Employment

EDUCATIONAL BACKGROUND:

Agreement:

Ambulance Service Application supplement