Job Application

APPLICATION FOR EMPLOYMENT

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to provide information necessary to evaluate suitability for employment. It is the policy of North Central Emergency Vehicles to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state or federal law. It is also the policy of North Central Emergency Vehicles to conduct pre-employment screening before a job offer is made. If a job offer is made, employment will be contingent upon the successful completion of background and drug testing. This application will remain active for 180 days.

PERSONAL INFORMATION

First Name*

Last Name*

Middle

Email*

Street*

State*

City*

Zip*

Since*

Length of time you've been at current address.

Home Phone*

Mobile Phone*

EDUCATION

High School Attended*

City, County & State*

Did you earn a diploma?*

Yes

GED

College Name / Grad School

City, State

Areas of Study

Degree / Certificate / Diploma

Trade, Business, Other School

City, State

Areas of Study

Degree / Certificate / Diploma

EMPLOYMENT INFORMATION

Position Applied For*

Date You Can Start Work*

Desired Salary or Hourly Rate*

Do You Prefer*

Full-Time
Part-Time

Can You Work*

Weekends
Evenings
No

Please answer all of the following questions. When necessary, note question number and use the additional comments space below provide explanations.

1.) Are you at least 18 years of age and legally eligible for work in the United States?*

2.) Will you work overtime when necessary?

3.) Have you received a description of the job or been made aware of the essential functions of the job you are applying for?*

4.) Do you understand the job requirements? (If no, please explain)*

5.) Are you currently bound by a noncompetition or trade secret agreement? (If yes, please explain)

6.) Have you ever been discharged or asked to resign from a job? (If yes, please explain)*

7.) Have you ever been charged with or arrested for any crime? (If yes, please explain)*

Additional Comments / If you were asked to explain any answer above, please do so here.

EMPLOYMENT HISTORY

Please list below your last three employers beginning with the most recent.

MAY WE CONTACT YOUR PRESENT EMPLOYER?*

Most Recent Employer*

Supervisor*

City*

State*

Zip*

Phone*

Position Held*

Start Date*
MM slash DD slash YYYY

End Date
MM slash DD slash YYYY

Pay Rate Upon Leaving*

Duties*

Reason for Leaving*

Next Most Recent Employer

Supervisor

City

State

Zip

Phone

Position Held

Start Date
MM slash DD slash YYYY

End Date
MM slash DD slash YYYY

Pay Rate Upon Leaving

Duties

Reason for Leaving

Next Most Recent Employer

Supervisor

City

State

Zip

Phone

Position Held

Start Date
MM slash DD slash YYYY

End Date
MM slash DD slash YYYY

Pay Rate Upon Leaving

Duties

Reason for Leaving

JOB-RELATED SKILLS

If the position you are applying for requires driving a motor vehicle, Please answer the following questions:

1.) Do you have a valid driver's license?*

2.) Have you been charged with or pled guilty to any traffic-related offense within the past five years?*

3.) Have you had your driver’s license suspended or revoked, or had your driving privileges modified by a court of law?*

Please list all states from which you hold or have held a driver’s license. (CTRL + CLICK to select multiple states)

Please use this space to list any special skills you may have that relate to the position applied for:

Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.

APPLICATION CERTIFICATION AGREEMENT

1. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
2. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release North Central Emergency Vehicles from all liability that might result from making the investigation.
3. If I am offered and accept a position, I agree to conform to all existing and future North Central Emergency Vehicles rules and regulations and I understand that North Central Emergency Vehicles reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.
4. I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.
5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

I agree to all of the above APPLICATION CERTIFICATION AGREEMENT*
Yes

Name
This field is for validation purposes and should be left unchanged.

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Apply for a job at North Central Emergency Vehicles online.

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EDUCATION

EMPLOYMENT INFORMATION

EMPLOYMENT HISTORY

JOB-RELATED SKILLS

APPLICATION CERTIFICATION AGREEMENT