EMS UNIVERSITY LLC EMPLOYMENT APPLICATION – Emergency Medical Services University, LLC

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Please type or print clearly. It is important that you answer all questions. Do no substitute a resume for the information requested.

THAT the Signature

Position Applying For:

WHERE DID YOU HEAR ABOUT US:

Date of Application:

Name

First

Last

Applicant Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

ARE YOU AT LEAST 18 YEARS OF AGE?

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 7 YEARS (EXCLUDING ANY SEALED OR EXPUNGED CONVICTIONS)?

Conviction will not necessarily disqualify an applicant from being certified as an instructor.

Have you ever had a state certification license suspended, revoked, placed on probationary status, or faced any disciplinary action for a state certification or license?

If you marked yes to either, please explain:

DID YOU GRADUATE FROM HIGH SCHOOL?

Name of High School

Education Level

TECHNICAL SCHOOLS, COLLEGES OR UNIVERSITIES

Degree(s) Received

Name of School

LICENSES, CERTIFICATES, OTHER COURSES OR TRAINING

Description

Issued By:

Expiration Date:

Number:

Employment History

Please list your employment history. Begin with your most recent position. Attach extra sheets if necessary, using the format below.

Job Title

Supervisor:

Employer:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

# OF HOURS WORKED PER WEEK

# OF EMPLOYEES SUPERVISED

Start Date

End Date:

DESCRIPTION OF JOB DUTIES/WORK PERFORMED:

Job Title

Supervisor:

Employer:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

# OF HOURS WORKED PER WEEK

# OF EMPLOYEES SUPERVISED

Start Date

End Date:

DESCRIPTION OF JOB DUTIES/WORK PERFORMED:

Job Title

Supervisor:

Employer:

Phone:

Address

Address Line 1

Address Line 2

City

State

Zip Code

# OF HOURS WORKED PER WEEK

# OF EMPLOYEES SUPERVISED

Start Date

End Date:

DESCRIPTION OF JOB DUTIES/WORK PERFORMED:

LIST OTHER SKILLS, ABILITIES, OR OTHER RELEVANT EXPERIENCES THAT WOULD HELP YOU FOR THE POSITION YOU ARE APPLYING FOR:

WHY ARE YOU INTERESTED INWORKING FOR EMS UNIVERSITY?

Supporting Documents

*Please upload a copy of your resume here:

Click or drag a file to this area to upload.

Authorizations

I hereby certify that all statements made in this application are true and complete to the best of my knowledge. I agree and understand that any misstatement of material fact contained inthis application may be cause for denial of this application, regardless of when or how discovered.

I certify

I authorize EMS University, LLC. to communicate with persons listed as former employers and any others with whom you desire to verify the statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liabilitythat might result from making an investigation.

I consent

Applicant Signature

Clear Signature

Date of Application

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Opening Hours:
Monday – Friday 7am – 7pm PST

Saturday & Sunday 7am – 7pm PST

Phone: (800) 728-0209
Email: info@emsuniversity.com

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Corporate Mailing Address:

501 South 48th Street, Suite 105, Tempe, AZ 85281

Our Locations: 501 South 48th Street, Suite 105, Tempe, AZ 85281 – 4945 East 29th Street, Tucson, AZ 85711 – 1730 SW Military Drive, Suite 202, San Antonio, TX 78217 – 6910 Miramar Road, Suite 206, San Diego, CA 92121 – 32980 Alvarado-Niles Road, Suite 810, Union City, CA 94587 – 1452 Hughes Road, Suite 360, Grapevine, TX 76051

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