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JOB APPLICATION

We are looking for highly motivated bright individuals to join our team.

ONLINE JOB APPLICATION FORM

 

Job App

PERSONAL INFORMATION:

Name
Name
First
Last
Position Interested In
Are you under 18 years of age?
Are you currently employed?
Have You Applied Here Before?

EDUCATION:

Did you graduated high school?
Did you graduate?

WORK HISTORY

May We Contact Your Employer?
May We Contact Your Employer?

VEHICLE OPERATOR INFO

Do you have a valid drivers license?
Have you ever had a driver license revoked or suspended?
Traffic Violation in the past five years?
Traffic accidents in the past five years?

CRIMINAL BACKGROUND

Ever been convicted of a misdemeanor and/or a felony?
Ever been cited for a summary offense?

GENERAL INFORMATION:

Do you have currently or a past history of a substance abuse problem?
Do you have any medical limitations that would prevent you from doing your job?

LIST ANY EMERGENCY SERVICES AFFILIATION

PERSONAL REFERENCES:

The Pittston Township Ambulance Association does not discriminate with regards to gender, race, religion, sexual orientation, political view or have any policy in regards to the same.
By submitting my application, I certify that the information contained herein are accurate to the best of my knowledge on the date of submission.  I hereby authorize review and investigation of all statements answered and contained herein and references and employers listed are permitted to provide you with information regarding my work history or personal background.  Any information they may and release, personal or otherwise, said persons and businesses are hereby released are held immune from any damage that may result from the utilization of such information provided.
I also understand and agree that no representative of this agency has any authority to enter into any agreement of employment unless signed by a representative of this agency.

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