Apply For EMS Job Twitter PERSONAL INFORMATION First Name: Last Name: Address: City: State: - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Phone: Email: Do you currently have a valid PA State Drivers license? * Yes No Do you have any driving violations in the last five years? Yes No I would like to apply to be: Paid Employee Volunteer EDUCATION Did you finish high school? Yes No Still student Name of High School Year Graduated: Did you finish college? Yes No Still student Name of college: Year Graduated Are you currently a licensed EMT? Yes No I'm a student License Number: EMT Expiration date Work Experience Name of company: Position: Salary Job 1: Start Date: End Date: Describe Responsibilities: Name of company 2: Position at job2: Salary: Start Date: End Date: Describe Responsibilities: Notice Pittston Township Ambulance Association takes your personal data protection seriously. We do not share your personal data with any third party without your prior consent. All information provided is confidential and securely stored using industry standard security. In the event you wish to have your information deleted please contact us by phone. In the event an offer of employment is being made, a detailed application will be required to be completed upon hire. Is the information being submitted accurate to the best of your knowledge and do you agree to permit any research of the information contained and submitted? Yes No