Name:
*
E-mail:
*
Telephone Number:
Address:
*
City:
*
State:
*
Zip:
Are you at least 21 years of age:
Yes/No
*
Yes
No
Applying for:
*
EMT-Basic
Pre-Hospital-RN
Medical-Biller
EMT-Intermrdiate
Medicar-Operator
Contact-EMT-Basic
EMT-Paramedic
Medical-Dispatcher
Contract-Paramedic
When can you start?
Type of employment:
Full Time
Part Time
Temporary
Seasonal
Ever been convicted of a Felony:
*
Yes
No
List your certifications and/or licenses including their issuing State, registered number and expiration date:
....
Previous Employment (prefer currant employer)
From:
To:
Position(s) Held:
Firm / Company:
Address of Employer:
Phone Number:
Supervisor:
Title of Supervisor:
Your Responsibilities:
Starting Salary & Title:
Ending Salary & Title:
Reason for Leaving:
May we contact this employer
Yes
No
I certify that my answers are true and complete to the best of my knowledge. I authorize ATS Medical Services, Inc. to make such investigations and inquiries of my personal, employment, educational, financial and other related matters that may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.
In the event I amn employed, I understand that false or misleading information givin in my application or interview(s) may result in discharge.
Upload Resume
*
