• APPLICATON FOR EMPLOYMENT

    Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other factor that is prohibited by Missouri or Federal Law. The District is an equal opportunity employer. This application will be considered only for one (1) year from the date on which you submit it. If you wish to be considered for employment after that time, you must submit a new application. Please complete the application in its entirety.

  • GENERAL INFORMATION

  • Please Enter Date & Time
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  • If hired, can you furnish proof you are eligible to work in the U.S.?*
  • Are you at least 18 years of age or older?*
  • Are you at least 21 years of age or older?*
  • Do you have a current State EMS license?*
  • Are you nationally registered?*

  • JOB INTEREST

  • Do you have reliable transportation to get you to and from work?*
  • Check each day you are available to work (please note that most positions require weekend availability)*
  • Type of employment desired (check all that apply)*
  • Are you willing to work (check all that apply)*

  • Employment History Information

  • Work History: Current and previous 2 employers (most current employer listed first)

  • Start Date
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  • Date Finished
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  • May we ask this employer for a reference?*

  • NEXT EMPLOYER

  • Start Date
     - -
  • Date Finished
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  •  -
  • May we ask this employer for a reference?*

  • NEXT EMPLOYER

  • Start date
     - -
  • Date Finished
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  • May we ask this employer for a reference?*

  • Additional Information

  • Have you ever been convicted of a felony?*
  • Have you ever been employed under a name other than the name used on this application?*
  • Do you agree to take a medical exam including drug and/or alcohol screening at the District's expense evaluating Occupational Qualifications of the position?*
  • Do you agree to take a fitness/lift test prior to employment?*
  • Do you agree to let Ste. Genevieve County Ambulace District to request a criminal background check prior to employment offer?*

  • EMS BACKGROUND

  • REFERENCES

    Please do not list relatives or former employers.

  • REFERENCE 1

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  • REFERENCE 2

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  • REFERENCE 3

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  • EDUCATION INFORMATION

  • HIGH SCHOOL

  • Did you graduate?*

  • COLLEGE OR UNIVERSITY

  • Did you graduate?

  • OTHER

  • Did you graduate?
  • Technical Education*
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  • PLEASE READ CAREFULLY

  • I understand and agree that, if hired my employment is "at will" and is not for a definate period and may, regardless of circumstances, be terminated at any time without prior notice by the Company. I further acknowledge that no contract of employment will be valid against the company unless signed by the Chief Operating Officer of the Company.

    I acknowledge that as a condition of my employment, I will be required to agree to be bound by the terms of and sign the Company. Failure to sign this Agreement shall result in revocation of my offer of employment.

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