Emergency Medical Technician- Basic at Western Turnpike Rescue Squad

First Name *

Last Name

Email *

Phone *

Resume *

In detail, please describe your availability: *

Please attach a copy of your driver's license, EMT certification, and CPR certification. *

For the sole purpose of the determination and evaluation of my motor vehicle operating record and pursuant to State and Federal regulations of compliance, I authorize Western Turnpike Rescue Squad to obtain my Motor Vehicle Driving Abstract for New York State through the LENS program. I understand that this record may contain personal information in addition to any/all violations or accidents. *

Furthermore I do affirm that I have not been convicted nor am I currently charged with any crime(s) related to: murder, manslaughter, assault, sexual abuse, theft, robbery, drug abuse, or sale of drugs. (10NYCRR-800.6F) *

I do affirm that I have no conditions that would preclude me from safely and effectively performing all of the functions of an active member of Western Turnpike Rescue Squad, Inc and that I have read the Functional Position Description and comply with that policy. *

I agree to take a physical examination at any time, at the request of Western Turnpike Rescue Squad, Inc. and at no personal expense to me, and agree that the examining physician may disclose the findings, in accordance to law and regulations, to the Western Turnpike Rescue Squad, Inc. *

Can you provide proof, if hired, that you are eligible to work in the U.S? *

Yes, I can.
No, I cannot.

Have you ever been excluded, or are you currently excluded, from participation in any federal or state health care programs? *

Yes
No

I certify that the information I have given on this application is true, complete and correct, and I understand that any false information or the omission of information may be considered as sufficient reason for denial of employment or termination of employment if I become an employee. Applications will remain active for six months, after which time reapplication will be necessary. *

See all the jobs at Western Turnpike Rescue Squad here: http://wtrs.recruiterbox.com/jobs

Application Form