Employment Application Form

We are located in Houston, Texas. If you apply be sure that you can work in Houston and have a Texas Certification. Also, our insurance requires that you are 23 years of age or older, but sometimes they may make exceptions.

CURRENT OPENINGS:

  • Experienced Ambulance Dispatchers
  • Medi-Lift (Wheelchair Van) Drivers
  • EMTs
  • Intermediates
  • Paramedics
Position <-Don't Check | Dispatcher Medi-Lift Driver EMT Intermediate Paramedic | Don't Check ->

General


 Last Name:
 First Name:   MI:
Are you 23 years old or older? Yes No
 Address:
 City: State:
 Zip:
 Phone:
 Email:

 

Education

School
Major/Area of Study
   High School or Equivalent
   EMT
   Paramedic
   College
   

 

Work Experience

List all current and previous work experience for the last ten years. Use the text box for additional information and experience.

Employer
Address 		Position
Type of Business 		Supervisor Phone Number Start Date
End Date
Employer
Address 		Position
Type of Business 		Supervisor Phone Number Start Date
End Date
Employer
Address 		Position
Type of Business 		Supervisor Phone Number Start Date
End Date
Employer
Address 		Position
Type of Business 		Supervisor Phone Number Start Date
End Date

Additional Information:

 

 

Certifications

Check all that apply

BCLS for Healthcare Providers PALS Provider
ACLS Provider BTLS Provider
Texas EMT Certification Texas Intermediate Certification
Texas Paramedic Certification Texas Paramedic License
Other:  

 

References

Name
Relationship
Phone
     
     
     

 

Are you available to work (Check all that apply):

Nights Weekends Holidays Part-Time Full-Time

Do you have a reliable method to ensure that you will arrive for work on-time?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, explain:

 

Where did you hear about our organization?

 

All ambulance operations positions require the performance of strenuous physical activity in unfavorable weather conditions, darkness, cramped spaces, etc. To the best of your knowledge, are you physically capable of completing these tasks?

Yes No

 

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge. I also understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements, references, and previous employment above to give you any and all information and any pertinent information that I may have, personal or otherwise. I also release Alliance Ambulance Inc. from all liability and damage that may result from the utilization of such information.

By submitting this form, you are agreeing to the statements presented on this page.

 

Alliance Ambulance inc. does not discriminate on the basis of race, creed, religion, belief, or sex. All applicants are afforded an equal opportunity to attain all positions identified in this announcement. Applicant IP address logged for verification. Produced by Alliance Ambulance Inc., September 2000, Copyright - All Rights Reserved.

 

 

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