Endeavor EMS Application

Endeavor Emergency Squad, Inc

Employment Application
Type of Employment
- Name
  
  First NameMiddle NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Cell Phone #
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Age
- Date of Birth
  
  MonthDayYear
  Date
- Social Security #
  ###-##-####
- Eye Color
- Height
- Weight
- Are you a citizen or legal resident of the United States? (In accordance with Federal Law, proof of US Citizenship or immigration status will be required if you are hired)
- Are you an EMT
- If yes, EMT ID
- Drivers License State
- Drivers License #
- Expiration Date
  
  MonthDayYear
  Date
- Has your drivers license ever been revoked
- If you answered yes, explain:
- Date available to start work
  
  MonthDayYear
  Date
- Are you currently employed
- May we contact your current employer
- Currently on layoff or subject to recall
- Please list up to 4 past employers
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still employed
- Business Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Job Title
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still employed
- Business Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Job Title
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still employed
- Business Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Job Title
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still employed
- Business Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Job Title
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still living here
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Date
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Date
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Date
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  If still in program leave blank
- Degree or Diploma
- School or Institution
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Date
- Degree or Diploma
- School or Institution
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Date
- Degree or Diploma
- School or Institution
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Date
- Degree or Diploma
- School or Institution
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still part of the organization
- Organization
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still part of the organization
- Organization
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still part of the organization
- Organization
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- From
  
  MonthDayYear
  Date
- To
  
  MonthDayYear
  Leave blank if still part of the organization
- Organization
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- As an applicant for a position with the Endeavor Emergency Squad, Inc., I understand and agree that I must provide truthful and accurate information in this application. I understand that I may be separated from employment if the Endeavor Emergency Squad later discovers that information on this form was incomplete, untrue, or inaccurate.
  
  I give Endeavor Emergency Squad the right to investigate the information I have provided and to talk with former employers.
  
  I give Endeavor Emergency Squad the right to secure additional job-related information about me. I release the Endeavor Emergency Squad and its representatives from all liability for seeking such information.
  
  I understand that Endeavor Emergency Squad is an Equal Opportunity Employer and does not discriminate in its hiring practices. I understand that Endeavor Emergency Squad will make reasonable accommodations as required by the Americans with Disabilities Act.
  
  I understand that employment with Endeavor Emergency Squad, Inc. is entered into voluntarily, and the employee is free to resign at will at any time with or without cause or notice. Similarly Endeavor Emergency Squad, Inc. may terminate the employment relationship at will at any time with or without cause or notice, so long as there is no violation of applicable federal or state law. This application is not intended to create a contract, nor is it to be construed to constitute a contractual obligation of any kind or a contract of employment between Endeavor Emergency Squad, Inc. and any of its employees.
  
  I understand that any offer(s) of employment may be subject to job-related medical, physical, drug, or psychological tests. I also understand that I may be subject to a complete background and criminal check.
- Signature
- Date
  
  MonthDayYear
  Date
Should be Empty:

Endeavor Emergency Squad, Inc

Please list up to 4 past employers