Employment Application

 

Name
Address
City	State Alaska Alabama Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip
Email
Phone	Social Security#
Certification	Emergency Responder EMT AEMT Paramedic PHRN PHPE MD DO # State Alaska Alabama Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Check here if you are 18 years of age.

Employment Desired

Position Emergency Responder EMT AEMT Paramedic PHRN Volunteer Shift Full Time Part Time Full or Part Time Date You Can Start:   Salary Desired:

Currently Employed? YesNo      May we contact previous employers? YesNo

Education

Highest grade level completed 9th Grade 10th Grade 11th Grade 12th Grade or GED College Freshman College Sophmore College Junior College Senior Masters or Doctorate Medical Command in the EHSF? YesNo

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? YesNo If so, where? Are you a veteran? YesNo

References

Tell Us About Yourself

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

Comments

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.