Trust Ambulance Job Application
Application for Employment

Trust is an equal opportunity employer and does not allow any unlawfully discriminatory practices associated with employment. Therefore, none of the questions on this employment application will be used for the purpose of limiting or excluding any applicant from consideration for employment as prohibited by local, state, or federal law. Equal access to employment, employee services, and programs is available to all persons. Any applicant(s) who require reasonable accommodations pertaining to the application and/or interview process should notify a representative of Trust Ambulance upon submitting the application for employment.

Instructions: Please enter your information. Answer all questions.

Position(s) Applied for: *
Required
Requested employment schedule: *
Required
Days Available *
Required
Hours Available *
Required
What date are you available to start work? *
Your answer
Personal Information
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Other Phone Number
(optional)
Your answer
Email *
Your answer
Drivers License Number: *
Your answer
Are you eligible to work in the United States? *
Have you been employed by Trust in the past? *
Have you been convicted of a felony? *
EMS CREDENTIAL INFORMATION:
Level of EMT Certification
Pennsylvania EMT Certification Number
Your answer
Valid Certifications
Other education, skills and/or qualifications for informational purposes:
(check all that apply)
EMPLOYMENT HISTORY:
Present or Last Position:
Employer:
Your answer
Address:
Your answer
Supervisor:
Your answer
Employers Phone Number:
Your answer
Position Title:
Your answer
Start Date:
Your answer
End Date:
Your answer
Responsibilities:
Your answer
Salary:
Input hourly wage, if not salaried.
Your answer
Reason for Leaving:
Your answer
Employer:
Your answer
Address:
Your answer
Supervisor:
Your answer
Employers Phone Number:
Your answer
Position Title:
Your answer
Start Date:
Your answer
End Date:
Your answer
Responsibilities:
Your answer
Salary:
Input hourly wage, if not salaried.
Your answer
Reason for Leaving:
Your answer
May we contact your previous employer *
If you answered No please explain?
Your answer
Reference 1: *
Name/Title:
Your answer
Phone *
Your answer
Reference 2: *
Name/Title:
Your answer
Phone *
Your answer
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