Medic On-Line Employment Application

Please remember to upload the required attachment to this application before submitting.


Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.

Please answer all questions.  Resumes are not a substitute for a completed application.  We are an Equal Opportunity Employer.  Applicants are consisered for positions without regard to veteran status, uniformed service member, race, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by federal, state, or local laws.  Where applicable, this company is an at-will employer as allowed by applicable state law.  This means that regardless of any provision in this application, if hired, the company may terminate the employment relationship at any time, for any reason, with or without notice.

Date*
Position you are applying for*

You are required to attach the following to this application:

  • HS Diploma or GED
  • MS Office certificate (preferred)
  • Medial Terminology certificate (preferred)
Name*
Address
Are you applying for:*
Which location are you applying for?
Are you at least 21 years of age?*
If hired, when can you start work?*
Have you ever applied to or worked for Medic before?*
Do you have any friends or relatives working at Medic Ambulance?*
How were you referred?*
If Hired, do you have a reliable means of transportation to and from work?*
If Hired, can you present evidence of your US Citizenship or proof of your legal right to live and work in this country?*
Are you able to perform the essential functions of the job for which you are applying?*

EDUCATION


 

Address
Did you graduate high school?*
Address
Did you graduate college or university?
Address
Do you speak, write or understand any foreign languages?*
Are you licensed/certified for the job applied for?*
Has your drivers license ever been suspended or revoked?*

EMPLOYMENT HISTORY

Are you currently employed?*
May we contact your employer?
Address
Start Date
End Date

 

Address
May we contact this employer?
Start Date
End Date

 

Address
May we contact this employer?
Start Date
End Date

 

Address
May we contact this employer?
Start Date
End Date

MILITARY SERVICE

Have you served or are you currently serving in the Armed Forces of the United States?*
Have you obtained any special skills or abilities as the result of service in the military that are applicable to the position you are applying for?

REFERENCES

Name
Address

 

Name
Address

 

Name
Address

Please Read Carefully, Initial Each Paragraph and Sign Below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge and I have read and fully understand the questions asked in this application. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Medic Ambulance Service to thoroughly investigate my references, work record, education, credit report and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview, which may be granted, or during my employment, if hired, is intended to create an employment contract between the company and me. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designed representative.

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid drivers license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state in which I reside. I further agree and give permission for Medic Ambulance Service to check my Motor Vehicle Records for insurability purposes.

If employed by Medic Ambulance Service, I understand and agree that the Company, to the fullest extent permitted by Federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement, as well as an agreement to arbitrate.

I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action up to and including immediate dismissal.

If hired, I agree to conform to the rules and regulations of the Company, and I understand that the Company has complete discretion to modify such rules and regulations at any time as allowed by law of contractual requirement, except that the Company will not modify its policy of employment at will where applicable.

Authorization for Background Investigation

I authorize Medic Ambulance Service to conduct a background investigation (to include a criminal background search, “Megan’s Law” inquiry, and previous employment verification) on me for possible employment purposes.


Use your mouse or finger to draw your signature above

DRIVING EXPERIENCE

Have you driven emergency equipment before?*
Have you ever had a license, or privilege to operate a vehicle

TO BE READ AND SIGNED BY APPLICANT

I understand that misrepresentation of information given above shall be considered an act of dishonesty. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

COMBINED DISCLOSURE NOTICE AND AUTHORIZATION

REGARDING BACKGROUND CONSUMER REPORTS

A consumer report and/or investigative consumer report including information concerning your character, employment history, general reputation, personal characteristics, police record, education, qualifications, motor vehicle record, mode of living and/or credit and indebtedness may be obtained in connection with your application for and/or continued employment with the employer. A consumer report and/or an investigative consumer report may be obtained at any time during the application process or during your employment with the employer. A consumer report containing injury and illness records and medical information may be obtained after a tentative offer of employment has been made. Upon timely written request of the personnel department of the employer, and within five (5) days of the request, the name, address and phone number of the reporting agency and the nature and scope of the investigative consumer report will be disclosed to you. Before any adverse action is taken, based in whole or in part on the

Information contained in the consumer report, you will be provided a copy of the report, the name, address and telephone number of the reporting agency, and a summary of your rights under the Fair Credit Reporting Act.

REASONABLE ACCOMMODATION

Title I of the Americans with Disabilities Act of 1990 (the "ADA") requires an employer to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, unless to do so would cause undue hardship. "In general, an accommodation is any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities." There are three categories of "reasonable accommodations":

"(i) modifications or adjustments to a job application process that enable a qualified applicant with a disability to be considered for the position such qualified applicant desires; or

(ii) modifications or adjustments to the work environment, or to the manner or circumstances under which the position held or desired is customarily performed, that enable a qualified individual with a disability to perform the essential functions of that position; or

(iii) modifications or adjustments that enable a covered entity's employee with a disability to enjoy equal benefits and privileges of employment as are enjoyed by its other similarly situated employees without disabilities."

The duty to provide reasonable accommodation is a fundamental statutory requirement because of the nature of discrimination faced by individuals with disabilities. Although many individuals with disabilities can apply for and perform jobs without any reasonable accommodations, there are workplace barriers that keep others from performing jobs which they could do with some form of accommodation. These barriers may be physical obstacles (such as inaccessible facilities or equipment), or they may be procedures or rules (such as rules concerning when work is performed, when breaks are taken, or how essential or marginal functions are performed). Reasonable accommodation removes workplace barriers for individuals with disabilities.

Reasonable accommodation is available to qualified applicants and employees with disabilities. Reasonable accommodations must be provided to qualified employees regardless of whether they work part- time or full-time, or are considered "probationary." Generally, the individual with a disability must inform the employer that an accommodation is needed

AUTHORIZATION

You hereby authorize and request, without any reservation, any present or former employer, school, police department, financial institution, division of motor vehicles, consumer reporting agencies, or other persons or agencies having knowledge about you to furnish the background check company with any and all background information in their possession regarding you, in order that your employment qualifications may be evaluated.

Use your mouse or finger to draw your signature above

REQUIRED ATTACHMENTS

REQUIRED ATTACHMENTS

EMT (Required with submission):

  • 5 year DMV Printout (within 2 weeks from date on application)
  • Valid California Driver License
  • TB (within 1 year)
  • Hepatitis B (3 sets)
  • Valid Ambulance Driver License
  • Current Medical Exam Card
  • EMT Accreditation Card (County or State)
  • Current BCLS Card

PARAMEDIC(Required with submission)

  • 5 year DMV printout (within 2 weeks from date on application)
  • Valid California Driver License
  • TB (within 1 year)
  • Hepatitis B (3 sets)
  • Current Ambulance Driver License
  • Current Medical Exam Certificate
  • Current BCLS Card
  • Current ACLS Card
  • Current PEPP or PALS Card
  • Current ITLS or PHTLS Card
  • Current State of California Paramedic License

REGISTERED NURSE (required with submission)

  • 5 year DMV printout (within 2 weeks from date on application)
  • Valid California Driver License
  • TB (within 1 year)
  • Hepatitis B (3 sets)
  • Current BCLS Card
  • Current ACLS Card
  • Current PEPP or PALS Card
  • Current State of California RN License

SUPPLY SERVICE TECHNICIAN (SST) (Required with submission)

  • 5 year DMV printout (within 2 weeks from date on application)
  • Valid California Driver License
  • TB (within 1 year)

OTHER APPLICANTS (Required with submission)

  • HS Diploma or GED
  • MS Office (Preferred)
  • Medical Terminology (Perfered)
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Have you attached the REQUIRED certifications?*

If you do not have enough upload bars for your certifications and/or supporting documents, please email certs to agen@medicambulance.net OR distribute certs in a word document, then upload document.