Careers

Application For Employment

Please Review Application Carefully. We Will not consider this application if not completed in full.

Please print or type. Complete All questions and sign on page 3.

"See Resume" is not a sufficient response to any question.

Last Name * First * Middle * Date of Application *
Street Address * Home Telephone
City, State, Zip Code Cell phone
Position Desired Data Available Salary Desired Social Security Number
Type of Employment Desired
Are you legally eligible for employment in this country? Yes     No
Full Time
Part Time

Temporary
Proof of U.S. Citizenship or immigration status will be required upon employment.

Education

Level Name and Location of School Diploma or Degree
(Credits Earned if No Degree)
Attandance Dates
From
Mo / Yr
To
Mo / Yr
Major
High School
Business, Trade or Technical*
College*
Graduate School*
Other*


Degree Name At Time Earned

The Heartbeat of The Antelope Valley

Employment History
Please provide a COMPLETE employment history, even if a resume is submitted with this application. List ALL employers, assignments or volunteer activities that are relevant to the job for which you are applying, starting with the most recent, including military employment. Explain any gaps in employment in the "Comments" section below. Please use the "Employment History Continuation Sheet" if additional space is needed.
(1) Present/Most Recent Employer Telephone Dates Employed
From
Mo/Yr
To
Mo/Yr
Summarize the nature of work performed and job responsibilities.
Address
Job Title
Hourly Rate / Salary
Starting (if Known)
Immediate Supervisor and Title
$
Per
Type of Employment
Full TimePart Time
TemporaryOther
Hourly Rate / Salary
Final
Reason for leaving or why you are considering leaving?
$
Per
If currently employed, may we contact for reference?
YesNo
(2) Next Previous Employer Telephone Dates Employed
From
Mo/Yr
To
Mo/Yr
Summarize the nature of work performed and job responsibilities.
Address
Job Title
Hourly Rate / Salary
Starting (if Known)
Immediate Supervisor and Title
$
Per
Type of Employment
Full TimePart Time
TemporaryOther
Hourly Rate / Salary
Final
Reason for leaving or why you are considering leaving?
$
Per
(3) Next Previous Employer Telephone Dates Employed
From
Mo/Yr
To
Mo/Yr
Summarize the nature of work performed and job responsibilities.
Address
Job Title
Hourly Rate / Salary
Starting (if Known)
Immediate Supervisor and Title
$
Per
Type of Employment
Full TimePart Time
TemporaryOther
Hourly Rate / Salary
Final
Reason for leaving or why you are considering leaving?
$
Per
(4) Next Previous Employer Telephone Dates Employed
From
Mo/Yr
To
Mo/Yr
Summarize the nature of work performed and job responsibilities.
Address
Job Title
Hourly Rate / Salary
Starting (if Known)
Immediate Supervisor and Title
$
Per
Type of Employment
Full TimePart Time
TemporaryOther
Hourly Rate / Salary
Final
Reason for leaving or why you are considering leaving?
$
Per



REFRENCES

List three business/work refrences who are NOT related to you and are NOT previous supervisors. If not applicable, list three school or personal refrences who are not related to you.

Name Telephone Years Known In what capacity is this person familiar with you and or your work?

PROFESSIONAL LICENCES

List any professional license(s) that are related to the position for which you are applying and list state(s) in which licensed:

SPECIAL ACCOMPLISHMENTS, PUBLICATIONS AND AWARDS

Exclude information that would revel sex, race, religion, national origin, age, color, or disability.

OTHER INFORMATION

Have you ever been convicted of, or are you now under charges for, any misdemeanor or felony offence? Omit (1) traffic fines, (2) any offence committed before your 18th birthday which was finally adjudicated in a juvenile court or under youth offender law, (3) any conviction the record of which has been expunged under law, and (4) any conviction set aside under the Fedral Youth Corrections Act or similar authority. (A yes response will not necessarily disqualify you from employment.) Yes No
If checked yes, please explain below:
Do you have any convictions or traffic violations that may prevent you from obtaining an ambulance drivers licence? Yes No
Do you ever applied to Antelope Ambulance Service before? Yes No    If so, when?
Have you ever interviewed for a job with Antelope Ambulance Service? Yes No    If so, when?
Have you ever employed by Antelope Ambulance Service? Yes No    If so, when?
Are any relatives or friends currently employed at Antelope Ambulance Service Yes No
Name of employee(s)
What prompted your application to Antelope Ambulance Service?

  Please indicate name of ad/friend
Antelope Ambulance Service Employee
Friend
Other