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5012 Bristol Industrial Way | Suite 110 | Buford, Ga 30518 (678) 546-8110

Patient Info


If you need information about medical records, need to pay an outstanding invoice, or want to know more about our policies, simple follow the links below
PAY INVOICE

Use our PayPal portal to submit your payment via credit or debit card

CONTACT FORM

We are a fairly small, flexible design studio that designs for print and web.

Amerimed EMS Online Application Form



Name


Email


Phone Number


Address






STATUS AND ELIGIBILITY

Are you a citizen of the U.S. or do you have the legal right to be employed in the U.S.
YesNo


Have you ever been convicted of any crime (excluding minor traffic violations)other than what was listed on previous page?
YesNo

If yes, please state the offense, location, date and disposition:


Do you have the physical ability to move and/or lift as required by the job for which you are applying?
YesNo


If No, please explain your limitations


Do you have the ability to work overtime if it is required by the job for which you are applying?
YesNo


If no, please explain



LOCATION DESIRED


Please indicte your preferred work location:


Barrow CountyCoweta CountyForsyth CountyHall CountyBibb CountyCook CountyWare County


EMPLOYMENT INFORMATION


Full-TimePart-TimeTemporary










If applying for field EMT position, are you 21 years or older?
YesNo




By clicking "Submit" I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading, or otherwise incorrect statements made on this application form or during any subsequent forms and/or during any interviews may be grounds for my immediate dismissal.


POLICIES/INFO
See our current HIPAA policies,  and get answers to commons questions