Employment Application
Sensible EMS Employment Application
Please enter all the mandatory (*) and applicable data
First Name
*
Please use your legal name
Middle
Last Name
*
Suffix
Other Name
Common Name you use if any
Home Street Address
*
City
*
State
*
TX
ZIP
*
Phone
*
Email
*
Social Security Number (format: XXX-XX-XXXX)
*
Driver's License
*
Driver's License Expiration Date
*
Position Applied For
Desired Compensation
EMT License type
*
EMT-B
EMT-I
EMT-P
Licensed-P
ECA
Other
EMT License #
*
EMT license expiration
*
How did your hear about us? Did someone referred you?
Are you applying for a Full-Time Position if avai
No
Yes
Will this be your primary job?
Yes
Will this be your only Job?
No
Yes
Do you have any scheduling issues?
Are you a citizen of the United States?
*
No
Yes
If no, are you authorized to work in the U.S.?
*
Yes
Have you ever worked for this company?
*
No
Yes
If so when?
Have you ever been arrested or convicted?
*
No
Yes
If yes, explain arrest
High School
Did you graduate HS?
No
Yes
College
Did you graduate College?
No
Yes
College Degree
Other Education
Professional Reference 1
Ref 1 Relationship
Ref 1 Company
Ref 1 Phone
Professional Reference 2
Ref 2 Relationship
Ref 2 Company
Ref 2 Phone
Previous Employment 1
Prev Empl 1 Phone
Prev Empl 1 Supervisor
Prev Empl 1 Job Title
Prev Empl 1 Starting Salary
Prev Empl 1 Ending Salary
Prev Empl 1 From__To
Prev Empl 1 Reason For Leaving
Previous Employment 2
Prev Empl 2 Phone
Prev Empl 2 Supervisor
Prev Empl 2 Job Title
Prev Empl 2 Starting Salary
Prev Empl 2 Ending Salary
Prev Empl 2 From____ To____
Prev Empl 2 Reason for Leaving
Previous Employment 3
Prev Empl 3 Phone
Prev Empl 3 Supervisor
Prev Empl 3 Job Title
Prev Empl 3 Starting Salary
Prev Empl 3 Ending Salary
Prev Empl 3 From__ To___
Prev Empl 3 Reason for Leaving
Military Service
Service From____ To___
Rank of Discharge
Type Of Discharge
Disclaimer and Signature
*
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
I, hereby, authorize you to do a background, credit and employment references check.
Please enter your name and date in lieu of a signature
File Attachments
Send me a copy of my responses
Email address
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