Volunteer Application

EMT/Driver Application

Join our crew and help a neighbor in a time of need!

Please answer all questions. If a question does not apply, please put N/A in the blank. If you need additional space you may add information in the comments section. The intentional omission of information on this application shall be sufficient cause for termination of employment.

Applications will remain active for 60 days and after that time must be re-submitted.
I am applying to become:*
I wish to volunteer in:*
PERSONAL INFORMATION
Full Name:*

First NameLast Name
Date of Birth:*
Age:*
E-mail:*
Home Phone #:*

Area CodePhone Number
Cell Phone #:*

Area CodePhone Number
When is the best time to contact you?*
Preferred means of contact?*
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to the Association?
REQUIRED INFORMATION FROM ALL APPLICANTS
Have you ever worked for the North Fork Ambulance?*
If yes, dates of service:
Do you have a current American Heart Association CPR for HealthCare Professionals Card?*
If yes, expiration date:
Are you a State of CO Certified EMT?*
If yes, certification # & level:
If you are an EMT is your National Registry Certification current?
Describe any advanced EMS related training you have completed.
Have you ever had a healthcare license or EMS certification revoked or suspended?
If you answered "Yes" to the question above, please explain.
Driver License Information
Do you have a valid Colorado license?*
If no, you MUST obtain one within 60 days of date of hire.
Current Driver License #*
Current License Classification:*
If you answer "Yes" to any of the following questions, you must provide an explanation in the comments section after the questions.
Has your license been suspended, cancelled or revoked in the past year?*
In the past year, how many traffic citations have you received?*
Have you EVER been arrested for Driving Under the Influence (DUI) of Alcohol or Drugs?*
If you answered yes above, explain here.
Criminal History
How long have you lived in Colorado?*
If you have lived in CO for less than a year, provide the date you moved to CO.
Have you ever been convicted of a Misdemeanor? If so, please explain in detail.*
Have you ever been convicted of a felony? If so, please explain in detail.*
Have you ever been convicted of any of the following?*
Do you have any special physical needs or restrictions that you would like us to be aware of?
Employment History

Please list the last three places of employment. If you have no employment history, please provide three (3) non-relative references we may contact.
Current Employer:
Employed since:
Supervisor:
Current position:
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Briefly describe your duties in this position and how you feel it relates to volunteering with the Ambulance.
Past Employer # 1
Position:
Start Date:
End Date:
Supervisor:
Phone Number

Area CodePhone Number
May we contact?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Briefly describe your duties in this position and how you feel it relates to volunteering with the Ambulance.
Reason for Leaving:
Past Employer # 2
Position:
Supervisor:
Start Date:
End Date:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Briefly describe your duties in this position and how you feel it relates to volunteering with the Ambulance.
Reason for Leaving:
Have you ever been fired or asked to resign from a job?
If yes to above, provide date of discharge, employer name and explanation.
Education/Training
High School
Did you graduate from High School?
If no, have you earned your GED?
Name & Address of High School or GED Training Facility
Trade/Technical School(s)
Name of Institution:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Course of Study:
Did you graduate?
Degree/Certificate(s) Earned and Dates:
Name of Institution
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Course of Study:
Did you graduate?
Degree/Certificate(s) Earned and Dates:
College
College/University:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?
Degree/Certificate Awarded:
Graduation Date:
College/University:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?
Degree/Certificate Awarded:
Graduation Date:
Describe any other specialized training not listed above.
General Comments Section

List any additional information you feel is important to your application and/or any references you wish to list or include three (3) references here if you have no work history.
Comments
Upload Documents
Please upload a copy of your Driver license, CPR card if you have one and a copy of your Colorado Driving History below.
Please Read the Following Statement Carefully Before Signing

By signing this application, I certify that all information contained herein is true and complete to the best of my knowledge. I understand that any false information or omission may disqualify me from further consideration for employment and may result in dismissal if discovered at a later date.

I authorize the investigation of any and all statements contained within this application. I also authorize, whether listed or not, any person, school, current employer, past employer, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

Employment with the North Fork Ambulance Association is at-will. Either the employee or management has the right to terminate the employment at any time, for any reason.
Background Check Agreement

By checking the box below, I agree to and understand that a Colorado Bureau of Investigation (CBI) background check will be completed prior to being hired by the North Fork Ambulance. I further acknowledge I have read and understand the above mentioned statements and acknowledge that I have read and understand the minimum requirements for the position for which I am applying as outlined on www.northforkambulance.com.

My electronic signature shall be an indication of my agreement to these conditions and is the same as my physical signature and I understand I may be asked to sign a copy of this application at a later date.
Signature

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PERSONAL INFORMATION

REQUIRED INFORMATION FROM ALL APPLICANTS

Driver License Information

Criminal History

Employment History

Education/Training

General Comments Section

Upload Documents