Downeast EMS
Work with Us
Email *
Name *
Email *
Date *
Address *
Phone *
Work Number *
May we contact you at work?  *
Position Desired (please include date available to start) *
Availability for work *
Shifts Available *
Have you previously worked for Downeast EMS? *
If yes, please list the location and when. If no, use NA *
Are you able to perform the essential tasks of the  job for which you are applying with our without accommodation?  *
Are you eligible to be lawfully employed in this country? Proof of citizenship or immigration status will be required upon employment. *
Are you 18 years of age or older? *
Have you ever been convicted of a class A, class B, class C, or class D crime in Maine, or a misdemeanor or felony in another state?
(This question is intended to exclude minor motor vehicle violations. Conviction of a crime will not necessarily disqualify you from consideration for a job. However, we do background checks with the Maine State Police Bureau of Identification and Motor Vehicle Bureau, an untrue response to this question is grounds for immediate dismissal.) If yes, please explain.
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Have you ever been listed by a federal agency as debarred, excluded or otherwise ineligible for a federal program participation?  *
Do you have any relatives employed by Downeast EMS?  *
Do you have adequate transportation?  *
Do you have adequate transportation?  *
Educational Background
Name and Address of High School *
Year of Graduation *
Name and Address of College *
Years Completed *
Year of graduation *
Degree or Diploma earned *
Have you been employed or received a degree, license, certificate, or registration under a different name? If so, what name? *
What are your plans for continuing education? *
Are you currently  *
Eligible for *
If you are licensed please include Date, Type, State Issued, and Number *
If you are registered please include Date, Type, State Issued, and Number *
If you are certified please include Date, Type, State Issued, and Number *
Please list any workshops, courses, or training (including military) which you feel are directly related to the position for which you are able to be considered.  *
Please indicate any special skills and/or qualifications that you possess that you feel directly relate to the position for which you are applying.  *
Please list any business, industrial, or healthcare equipment that you are skilled at operating. *
Employment History
Please list all of your previous jobs, beginning with your present or most recent position. Please include military, self-employment, summer and part-time jobs. If you have a resume, please attach as well as completing the employment history below. *
References - Please list 3 
Please list three references including Name, phone, and contact information. *
Please read, sign, and date
It is the policy of Downeast EMS to provide equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, ancestry, or national origin, or to persons with a mental or physical disability who are otherwise qualified. Downeast EMS is firmly committed to providing equal employment opportunities to qualified individuals with disabilities, qualified disabled veterans, and veterans of the Vietnam era. No question on this application is intended to secure information to be used for illegal, discriminatory purposes. In compliance with state law, Downeast EMS has adopted a policy which prohibits smoking by employees in any part of the building. Outside smoking areas have been designated. Any job offered by Downeast EMS is conditioned upon: 
1. Receipt of acceptable recommendations for reference. 
2. Proof of U.S. citizenship or appropriate visa or work permit. 
3. Successful completion of a pre-employment physical examination. The position for which you have applied requires that if selected for employment or placed on a roster of eligibility, you must submit to a substance abuse test and receive a negative result before being employed. Each person being tested will receive a copy of our corporate Substance Abuse Testing Policy approved by the state of Maine. 
4. If the position for which a job offer is being made requires or permits you to drive as part of your job duties, you must submit proof of driver's license and an acceptable driving record. A copy of Downeast EMS written policy on driving is available for review from the manager of the operating division to which you have applied. You may obtain additional information by contacting the Downeast EMS office at P.O. Box 552, Calais, ME 04619. A copy of our corporate written policy concerning substance abuse testing approved by the state of Maine is available for review from the manager of the operating division to which you have applied. You may obtain additional information by contacting Downeast EMS at P.O. Box 552, Calais, ME 04619. 

I hereby certify that the information provided by me on this application is correct and complete to the best of my knowledge and belief. I acknowledge that any false or misleading statement of fact or material omission from my application may result in immediate dismissal if employed, or in the case of an applicant, may result in refusal of employment. I have read and understand Downeast EMS’s statements in regards to equal employment opportunity, smoking and conditions of any job offered that may be made to me. I authorize Downeast EMS to verify any of the information contained in this application.
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