Application for Employment

Application for Employment
Thank you for your interest in working for VersaCare Emergency Medical Services, Inc.

VersaCare EMS is an equal opportunity employer. We provide equal employment opportunities for all, without regard to race, color, religion, sex, sexual preference or orientation, national origin, age, disability, veteran status or any other non job-related characteristic protected by law.

We are hiring for the following part-time positions:
- Office Assistant
- EMR
- EMT or Paramedic
- RN

For a non-medical position, you MUST have:
- CA ID or Driver's License
- Immunization information (COVID-19, Hepatitis B and Influenza)
For a medical position, you MUST have:
- Your CA EMT certificate, CA Paramedic License, or CA RN license
- BLS provider card
- ACLS (for Paramedics and RNs)
- Immunization information
You will be signing this application electronically. You will be uploading the following:
- EMR certification, EMT certification, Paramedic licensure, or RN license
- AHA BLS for Healthcare Provider (or equivalent)
- AHA ACLS certification (or equivalent, Paramedics and RN applicants only)
- CA Driver's License
- Immunization status (COVID-19, Hepatitis B and Influenza)
Additionally, you may also upload the following optional items:
- DOT Medical Examiner's Certificate (aka DL-51)
- CA Ambulance Driver's Certificate
- PPD Status (must be less than 1 year old)
- PALS Provider certification (or equivalent, Paramedics and RN applicants only)
- PHTLS certification
- NREMT certification (EMTs and Paramedics only)
- Resume'
If you are invited for an interview and testing, you will need to bring in all original certifications/licensures that were submitted, and also sign a statement attesting that you filled out the application truthfully and accurately.
________________________________________________

YOUR DEMOGRAPHICS
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Email*
example@example.com
SSN*
Date of Birth (mm/dd/yyyy

MonthDayYear
Date
Have you ever been convicted of a felony or serious misdemeanor?

YesNo
If yes, please explain:

EMPLOYMENT REFERENCES
Employer #1:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor:
May we contact this employer?

YesNo
Employer #2:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor:
May we contact this employer?

YesNo
Employer #3:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor:
May we contact this employer?

YesNo

PERSONAL REFERENCES
Reference #1:
Reference #1 Phone Number

Area CodePhone Number
How do you know Reference #1?
Reference #2:
Reference #2 Phone Number

Area CodePhone Number
How do you know Reference #2?
Reference #3:
Reference #3 Phone Number

Area CodePhone Number
How do you know Reference #3?

INFORMATION AND SIGNATURE
Why are you interested in working for VersaCare EMS?
Is there anything you would like us to know about you?
I am applying for a position at VersaCare EMS. I understand and agree that VersaCare EMS, to the extent permitted by federal, state, and local law, may, without prior warning or notice, conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, equipment, inventories, computers, and phones). I understand that in certain circumstances, this may also include my personal property.

I understand that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required and agree to sign an arbitration agreement, as well as a confidentiality (Non-disclosure) agreement. For positions as an EMT or Paramedic, I may be required to obtain and maintain a CA driver's license, DL-51, and CA Ambulance Driver's Certificate/Endorsement, as a condition of hire or continuing employment (Note: We do hire individuals who are unable to obtain a CA Driver's license and/or Ambulance Driver's Certificate/Endorsement, on a case-by-case basis).

I am signing this application, attesting that this information is true and accurate.
You may sign your application one of two ways,

If you have a touchscreen, please sign on the line below:
Sign your application here:

Clear
IF YOU DO NOT HAVE A TOUCHSCREEN AND CANNOT SIGN WITH YOUR SIGNATURE, type your first and last name below. By typing your name, you are signing this application electronically.
Should be Empty: