Employment Application

 
Name  
Address
City   Zip
Email  
Phone Social Security#
Certification #
 

Employment Desired

Date You Can Start:   Salary Desired:
Currently Employed?      May we contact previous employers?

Education

Medical Command in the EHSF?
 
 
List any professional designations: List other skills/qualifications:

Employment History

Which of these jobs did you like best and why?
Have you volunteered for any EMS? If so, where? Are you a veteran?

References

Tell Us About Yourself

Please tell us why you like working in EMS and why you'd like to work at Warwick Ambulance:

Emergency Contact

   
Please attach the following certificates and licenses:
  • EMT
  • CPR
  • EVOC
  • Drivers License
  • ICS
  • Hazmat
  • Bloodborne Pathogens
  • HIPAA


I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered my application may be rejected and, If I am employed, my employment may be terminated at any time. I agree to a criminal background check, driver's information check and pre-employment physical, including drug testing, prior to employment. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminatated with or without cause and without notice. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice at any time by the company.

Today's Date: Signature:  



About Us

  1. We are a combined volunteer/career organization that provides Basic Life Support, Advanced Life Support, and wheelchair van services to the community.
  2. Qualifications to volunteer (Items in RED are required for employment) are:
    • BLS crew member:
      • CPR
      • EMT, Emergency Responder, or First Responder
      • EVOC
    • ALS Crew member:
      • CPR
      • EMT-P or PHRN
      • ACLS
      • EVOC
    • Wheelchair Van Crew members are certified in CPR
  3. Volunteers are asked to commit to 24hrs per month of on-call time.
  4. During call time, volunteers need only be within 5 minutes of the station. The only exception is a MICU qualified volunteer, they must stay at the station.
  5. Warwick Ambulance's call volume exceeds 4500 responses per year.
  6. Warwick Ambulance is a certified CEU location.
  7. An observer program is available to those who are unsure if they want to become a volunteer.
  8. Warwick Ambulance is sponsored & owned by the Lititz AMBUCS.