Yellow Breeches EMS Application
What level Certification do you hold currently?
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
If you are under the age of 18 and it is required, can you furnish a work permit?
If no, please explain
Have you ever been employed here before? If yes, please give dates and positions held. If no, put N/A
Are you legally eligible for employment in this country?
Date available for work
What is your desired salary range?
Type of employment desired
Seasonal (College Students)
Are you able to perform the "essential functions" of the job for which you are applying for (with or without reasonable accommodation). Hover your mouse over this question for more info
Need more information about the job's "essential functions" to respond
Have you pleaded "guilty" or "no contest" to, or been convicted of, of crime
If yes, please provide date(s) and details
Employer and phone number
Starting job title/final job title
Immediate supervisor and title (for most recent position held)
Why did you leave?
Where you hourly or salary?
Dates Employed (DD/MM/YYYY) - (DD/MM/YYYY)
May we contact for reference
Any bonus, Commissions/ other compensation
Previous Employment Compensation
Summarize any special training, skills, licenses and/or certifications that may assist you in performing the position for which you are applying. If none, put N/A
Starting with the most recent school you attended, fill out the chart below with your educational background.
School (include City & State)
Diploma or Degree
If Degree, what is/was your major and minor
GPA / class rank
Type a question
Relationship to you
Number of Years known
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims i may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
By signing your name below, you accept all terms of the foregoing Application Statement and certify that all information on this application is the truth to the best of your knowledge.
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