EmailMe Form - Application for Employment

Full Name:

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

Phone

### - ### - ####

Position applying for:

Which service are you applying for?

Are you applying for:

Full time

Part time

Either

Are you a US citizen?

Yes

No

Gender

Male

Female

Current certification:

License Number:

State certification is issued:

Year your first medical certification was obtained:

When can you start?

EMS service most recently employed at:

Current employer name and address:

Current Employer Phone Number:

### - ### - ####

Name of Supervisor:

May we contact your current employer?

Yes

No

Prefer at a later time.

Name & relationship of a personal reference:

Reference Phone Number

### - ### - ####

Certifications/Licenses currently held:

(Hold down control key and select all that apply)

Has your certification ever been suspended or revoked?

Yes, See below for more information

No

Suspended/Revoked explanation:

Additional Certifications/Qualifications:

(Hold down control key and select all that apply)

Have you ever been convicted of a felony or do you currently have any pending lawsuits/charges pending against you?

Yes, See Below

No

Explanation of felony or pending charges:

Driver's License Number:

Issue State of Driver's License:

List any traffic violations on your driving record, including accidents and citations:

Additional Remarks/Comments:

If you would like to send an official resume, attach here:

Important Information: The information provided above is true and correct to the best of my knowledge and I have a genuine intent and no other purpose in applying for a job with Techs, Inc. I understand that any misrepresentations, falsifications, or willful omissions, will make me ineligible for employment and, if employed prior to such information becoming known to Techs, Inc., will result in my dismissal from employment. In return for the considerations of my application for employment, Techs, Inc. has my permission to contact my current and former employers for references. To the extent it deems pertinent for the decision regarding my employment, to obtain or review any records available to employers or the public that are maintained by any governmental, law enforcement or licensing agencies.

I authorize my present and former employers, and/or any person(s) acting on their behalf, to release to Techs, Inc. any and all information pertaining to my former employment, in return for its consideration of my application for employment. I release Techs, Inc. and my present and former employers from any and all liability for any damages that may occur as a result of this exchange for information. Techs, Inc. is an equal opportunity employer.

Check here if you have read and understand the statements included in the "important information" section above. Signed via electronic by submitting from your personal account via email. Applicant understands an additional application may be required at a later time. *

Yes, I understand additional important information.

Signature

Clear

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ACLS
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
CPR Instructor
CPR Healthcare Provider
CPR Lay Person
Critical Care Nurse
Critical Care Paramedic
Critical Care Flight Certified
EVOC
Firefighter
Hazmat Awareness
Hazmat Operations
Instructor/Coordinator
Law Enforcement Official
NIMS
PALS
PHTLS
Red Cross Life Guard
Safety Officer
TO I
TO II
Wildlife & Parks Employee
Other, See remarks