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Job application form
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Name
*
First and last name
Your answer
Email
*
Your answer
Home address
Your answer
Phone number
*
Your answer
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:
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Do you have reliable transportation getting to/from work?
Yes
No
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Desired salary
Your answer
Date available to start work
MM
/
DD
/
YYYY
Are you a U.S citizen?
Yes
No
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Willing to take a drug test for pre-employment as well as randoms
Yes
No
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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)
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Have you ever been convicted of a felony ?
Yes
No
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Are you willing to submit to a pre-employment drug screening test ?
Yes
No
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Employment history
Your answer
Reason for leaving last employement
Your answer
I Certify that all answers given herein are true and complete to the best of my knowledge.
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No
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