Step 1 of 2

  • Date Format: MM slash DD slash YYYY
  • List below all of your EMS training, where you received this training and how many hours of instruction you have received:
  • Date Format: MM slash DD slash YYYY
  • Please list 3 references (not relatives)

  • Reference #1

  • Reference #2

  • Reference #3

  • Following is a list of requirements and/or responsibilities of Ambulance Service Members:

    1. You must be able to assist lifting the ambulance cot with a patient. The total weight would be approximately 100 pounds. The cot with patient would be lifted from the ground to the ambulance floor (approx. 3 feet).

    2. You will be required to take a minimum of 24 hours of call per month and 12 Holiday call hours in a year.

    3. You will be required to attend no less than 8 of the 12 monthly meetings and training sessions.

    4. You will be required to pass a physical examination as described by our Medical Director.

    5. You must live in or work within 10 minute drive time to ambulance garage.

    I authorize investigation of all statements contained in this application for employment as may be necessary to determine eligibility for employment. I certify that answers given herein are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time. Applicant may be subject to a random drug screen.

  • Date Format: MM slash DD slash YYYY