Job application form

Please fill out bellow

Name *

First and last name

Email *

Home address

Phone number *

Which position(s) are you interested in? *

EMT (Emergency Medical Technician) (Requires NJ EMT Valid Certification)

MAVO(Mobility Assistant Vehicle Operator) (Requires MAVO Certs(In house training available)

Livery Driver (sedan driver) (Must have clean MVR)

Office employee (Call taker/Dispatcher)

Medical Biller (Experience necessary)

Ambulance Driver *NEW (Clean driving record, CPR, be fit to transfer and lift pts)

Required

Seeking

Full Time (36 HRS+)

Part Time (Less than 30 HRS)

Graveyard shift(overnight shifts or late night shifts)

Seasonal

Other:

Clear selection

Do you have reliable transportation getting to/from work?

Yes

Clear selection

Desired salary

Date available to start work

YYYY

Are you a U.S citizen?

Yes

Clear selection

Willing to take a drug test for pre-employment as well as randoms

Yes

Clear selection

Please tell us about your driving record (MVR) if applying for driving position

CLEAN(no points, no accidents)

MEDIUM ACTIVITY(some points, no suspensions, no more than 4 moving violations in last 3 years)

COMPLICATED (have points or accidents that can be explained with paperwork)

N/A (Not applying for driving position) (ex:office worker, non driving emt)

Clear selection

Have you ever been convicted of a felony ?

Yes

Clear selection

Are you willing to submit to a pre-employment drug screening test ?

Yes

Clear selection

Employment history

Reason for leaving last employement

I Certify that all answers given herein are true and complete to the best of my knowledge.

Yes

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