Arlington Rescue Squad Inc. Employment Application

Arlington Rescue Squad Inc. Employment Application

Thank you for taking the time to apply for employment here at the Arlington Rescue Squad. Our employees play an important part in our organization. Their dedication makes it possible for the rescue squad to continue to provide emergency medical services to our community and surrounding areas. All information contained in this application will be kept confidential and is for the use of Arlington Rescue Squad only. All applicants, if hired, will be required to have a physical, and be required to take mandatory OSHA and HIPAA training course(s) at time of orientation. All employees are required to meet the guidelines and criteria as defined in the Arlington Rescue Squad Inc Standard Operating Guidelines, By-laws and Constitution. Arlington Rescue Squad considers applications for employment without regard for race, color, religion, sex national origin, age, disability, veteran status, or any other characteristics protected by law.**ARLINGTON RESCUE SQUAD IS A DRUG-FREE/SMOKE FREE WORKPLACE.**
Full Name*

First NameMiddle NameLast Name
Date of Birth:*

MonthDayYear
Date
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number*

Area CodePhone Number
Applying for Position*
Drivers License Number:*
Drivers License State:*
CPR Card:*

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National Registry Card:*

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Vermont State EMS Card (if applicable):

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Have you ever applied to or been a member of, Arlington Rescue Squad Inc?*

YesNo
When? (To the closest month)

MonthDayYear
Date
Have you ever been a member of another emergency service organization?*

YesNo
Please list them here, as well as dates of affiliation, and reason for leaving if applicable:
Have you ever been convicted of any crime (misdemeanor or higher) in any jurisdiction?*

YesNo
Please explain:
Have you ever had your EMS certification suspended or revoked?*

YesNo
Please explain:
References

Please include three (3) references. Please do not include any family members
Reference One*

First NameLast Name
Title, Company (or relationship)*
Phone Number*

Area CodePhone Number
Reference Two*

First NameLast Name
Title, Company (or relationship)*
Phone Number*

Area CodePhone Number
Reference Three*

First NameLast Name
Title, Company (or relationship)*
Phone Number*

Area CodePhone Number
When would you be available for an interview?
Certification of Truth

By submitting this application I herby certify that all the information and attachments are true and valid to the best of my knowledge. I acknowledge that if an investigation discloses intentional omissions, misrepresentations, or falsifications my application will be rejected. In that case that such intentional omissions, misrepresentations, or falsifications are disclosed after acceptance to the membership of Arlington Rescue Squad Inc. I accept that such discoveries may be cause for termination of membership.
I have read and agree to the Certification of Truth.*

Yes
Consent to Perform Background Check

By submitting this application I herby authorize Arlington Rescue Squad Inc. to perform a background check at their discretion. This may include, but is not limited to: Interviewing former/current employers, Interviewing former/current organizations where I have been a member, Interviewing any other entity of which I have been affiliated with. I herby release any entity or individual that provides information pursuant to this cause from legal action or suit of any kind.
I have read and agree to the Consent to Perform a Background Check.*

Yes
Please attach your resume:

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Enter the message as it's shown*
Signature*

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Arlington Rescue Squad Inc. Employment Application

References

Certification of Truth

Consent to Perform Background Check