EmailMeForm
Courtesy Ambulance Service LLC. Job Application
Personal Information
Name
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First
Last
Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Home Phone Number
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Cellular Phone Number
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Email
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Are you eligible to work in the United States?
*
Yes
No
POSITION/AVAILABILITY:
Position Applied For
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Florida Driver License Number
*
What date are you available to start work?
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MM
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DD
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YYYY
Have you ever been convicted of a felony?
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No
Yes
If Yes, explain
EDUCATION:
Name and Address Of School - Degree/Diploma - Graduation Date
*
Skills and Qualifications: Licenses, Skills, Training, Awards
*
EMPLOYMENT HISTORY:
Present Or Last Employer:
Employer:
Address:
Supervisor:
Phone Number
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Position Title:
Start Date
MM
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DD
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YYYY
End Date
MM
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DD
/
YYYY
Responsibilities:
Salary
Input hourly wage, if not salaried.
Reason for Leaving:
Previous Position
Employer:
Address:
Supervisor:
Phone Number
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Position Title:
Start Date
MM
/
DD
/
YYYY
End Date
MM
/
DD
/
YYYY
Responsibilities:
Salary
Input hourly wage, if not salaried.
Reason for Leaving:
May We Contact Your Present Employer?
*
Yes
No
References:
Name/Title Address Phone
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
AT-WILL-EMPLOYMENT
The relationship between you and Courtesy Ambulance Serive LLC is referred to as "Employment at will" This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Courtesy Ambulance Service LLC.No representative of Courtesy Ambulance Service LLC has the authority to enter into any agreement contray to the foregoing "employment at will" relationship. You understand that your employment is "at will" and that you acknowledge that no oral or written statement or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and the Company's President.
Do you agree with the terms and conditions?
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Yes, I agree.
Initial
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Date
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MM
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DD
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YYYY