Paid Employment Application

Paid Employment Application

EMT Employment Application

Please complete all sections and review the legal statement before submitting.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
When can you start?

MonthDayYear
Date
Have you previously applied for a position at PVAC before?
Were you hired the last time you applied to PVAC?
Were you forcefully discharged from employment from PVAC?
Why were you discharged from PVAC?
Reason you were not accepted last time?
Were you referred to PVAC by a current volunteer or employee?

Who referred you?
Do you agree to be enrolled in the Philipstown VAC DMV Lens program, which monitors your driver’s license activity periodically?
Are you legally authorized to work in the United States?
Will you now or in the future require sponsorship for employment visa status?
Are you currently certified as an EMT in New York?
Upload EMT Card

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Are you CPR Certified?
Upload CPR Card

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Do you have a valid driver's license?
Upload Driver’s license

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Please list any additional relevant certifications (e.g, ACLS, EVOC, FEMA ICS, PALS)
Upload Additional Certifications

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Education
Education (highest level completed)
Are you currently enrolled in school?
Work Experience
Do you have previous employment experience
May we contact your previous employers?
Company Name 1
Position Held 1
Company Phone Number 1
Please enter a valid phone number.Format: (000) 000-0000.
Are you still employed with this company? 1
Start Date 1

MonthDayYear
Date
End Date 1

MonthDayYear
Date
Additional work history?
Company Name 2
Position Held 2
Company Phone Number 2
Please enter a valid phone number.Format: (000) 000-0000.
Are you still employed with this company? 2
Start Date 2

MonthDayYear
Date
End Date 2

MonthDayYear
Date
Additional work history?
Company Name 3
Position Held 3
Company Phone Number 3
Please enter a valid phone number.Format: (000) 000-0000.
Are you still employed with this company? 3
Start Date 3

MonthDayYear
Date
End Date 3

MonthDayYear
Date
Professional References
Name 1

First NameLast Name
Phone Number 1
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Reference 1
Name 2

First NameLast Name
Phone Number 2
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Reference 2
Name 3

First NameLast Name
Phone Number 3
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Reference 3

Upload Resume (PDF or DOC)

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I certify that all information provided is true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application as may be necessary in arriving at an employment decision. I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand that I may be subject to a background check as required by NYS.

Philipstown Volunteer Ambulance Corps is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other protected status in accordance with applicable federal, state, and local laws.

I understand that, as a condition of employment, a background check may be conducted. I authorize Philipstown Volunteer Ambulance Corps to verify the information provided and conduct any necessary background investigations.

All personal information provided in this application will be kept strictly confidential and used solely for employment purposes. It will not be shared with third parties without consent.

I understand that if I am hired, my employment may be subject to the terms and conditions of a collective bargaining agreement between the employer and the applicable labor union. To the extent that a collective bargaining agreement applies, the terms of that agreement will govern wages, hours, working conditions, discipline, and termination. Nothing in this application is intended to create a contract of employment. If hired, I agree to comply with all employer policies and procedures as well as any applicable collective bargaining agreement.
Applicant Signature
Date of Signature

MonthDayYear
Date
Should be Empty: