Amerimed EMS Online Application Form



Name


Email


Phone Number


Address






STATUS AND ELIGIBILITY

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


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:


North GeorgiaMiddle GeorgiaSouth GeorgiaEastern TennesseeMiddle TennesseeWestern TennesseeNorthern MississippiOhioIndianaSouth Carolina


EMPLOYMENT INFORMATION


Full-TimePart-TimeTemporary








Date available to start




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.