EMSU EMPLOYMENT APPLICATION – Emergency Medical Services University, LLC

Please type or print clearly. It is important that you answer all questions. Do no substitute a resume for the information requested.

Position Applying For: *

WHERE DID YOU HEAR ABOUT US: *

Date of Application: *

Name *

First

Last

Applicant Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

ARE YOU AT LEAST 18 YEARS OF AGE? *

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 7 YEARS (EXCLUDING ANY SEALED OR EXPUNGED CONVICTIONS)? *

Conviction will not necessarily disqualify an applicant from being certified as an instructor.

Have you ever had a state certification license suspended, revoked, placed on probationary status, or faced any disciplinary action for a state certification or license? *

If you marked yes to either, please explain:

DID YOU GRADUATE FROM HIGH SCHOOL? *

Name of High School

Education Level

TECHNICAL SCHOOLS, COLLEGES OR UNIVERSITIES

Degree(s) Received

Name of School

LICENSES, CERTIFICATES, OTHER COURSES OR TRAINING

Description *

Issued By: *

Expiration Date: *

Number: *

Employment History

Please list your employment history. Begin with your most recent position. Attach extra sheets if necessary, using the format below.

OR High denial

Job Title

Supervisor:

Employer:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

# OF HOURS WORKED PER WEEK *

# OF EMPLOYEES SUPERVISED *

Start Date

End Date:

DESCRIPTION OF JOB DUTIES/WORK PERFORMED:

Job Title

Supervisor:

Employer:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

# OF HOURS WORKED PER WEEK *

# OF EMPLOYEES SUPERVISED *

Start Date

End Date:

DESCRIPTION OF JOB DUTIES/WORK PERFORMED:

Job Title

Supervisor:

Employer:

Phone:

Address

Address Line 1

Address Line 2

City

State

Zip Code

# OF HOURS WORKED PER WEEK *

# OF EMPLOYEES SUPERVISED *

Start Date

End Date:

DESCRIPTION OF JOB DUTIES/WORK PERFORMED:

LIST OTHER SKILLS, ABILITIES, OR OTHER RELEVANT EXPERIENCES THAT WOULD HELP YOU FOR THE POSITION YOU ARE APPLYING FOR:

WHY ARE YOU INTERESTED INWORKING FOR EMS UNIVERSITY?

Supporting Documents

*Please upload a copy of your resume here: *

Drag & Drop Files, Choose Files to Upload

Authorizations

I hereby certify that all statements made in this application are true and complete to the best of my knowledge. I agree and understand that any misstatement of material fact contained inthis application may be cause for denial of this application, regardless of when or how discovered. *

I certify

I authorize EMS University, LLC. to communicate with persons listed as former employers and any others with whom you desire to verify the statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liabilitythat might result from making an investigation. *

I consent

Date of Application *

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Opening Hours:
Monday – Friday 7am – 7pm PST

Saturday & Sunday 7am – 7pm PST

Phone: (800) 728-0209
Email: info@emsuniversity.com

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Corporate Mailing Address:

501 South 48th Street, Suite 105, Tempe, AZ 85281

Our Locations: 501 South 48th Street, Suite 105, Tempe, AZ 85281 – 4945 East 29th Street, Tucson, AZ 85711 – 1730 SW Military Drive, Suite 202, San Antonio, TX 78217 – 6910 Miramar Road, Suite 206, San Diego, CA 92121 – 32980 Alvarado-Niles Road, Suite 810, Union City, CA 94587 – 1452 Hughes Road, Suite 360, Grapevine, TX 76051

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