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Position Applying For
Previous Employer Information I
Previous Employer Information II
Previous Employer Information III
Please list the name and contact information of up to 3 professional references.
College Attended & Field of Study
Do you have any type of criminal history that we should know about?
By obtaining employment with Priority One EMS:
I will not be in violation of any probation or parole conditions I am not a sex offender I have no restrictions or injunctions preventing me from being in contact with certain individuals I consent to allow PRIORITY ONE EMS to conduct a criminal history check I certify that the information I have given on this application is true, complete and correct, and I understand that any false information, or the omission of information may be considered as sufficient reason not to be considered for employment or for my discharge if hired. I recognize that completion of this application does not mean that job openings exist and does not obligate PRIORITY ONE EMS in any way. Applications will remain active for six months, after which time reapplication will be necessary. If hired, employment will be “at will” and either I or PRIORITY ONE EMS is free to terminate the employment relationship at any time without cause and without prior notice. This application is not an agreement or a contract for employment. If offered a position and at any time thereafter, I consent to medical examinations as may be required to determine my fitness to perform the job duties. I understand that I may be required to undergo drug screening tests as a condition of employment. To comply with this requirement, I consent to providing a sample of my urine or other physical samples (such as blood or hair) prior to employment and again at any time so requested. Specimens will be tested for both legal (prescription drugs) and illegal substances. A positive test for legal substances will require proof of a current prescription. I further consent to allow any doctor, hospital or testing laboratory to conduct any medical test or examination as may be required by PRIORITY ONE EMS as a condition of my employment, and I hereby give my consent to the release of all information which PRIORITY ONE EMS deems necessary to determine my ability to perform job duties now or in the future. I further understand that refusal to submit to an alcohol or drug screen test at any time will result in immediate discharge from PRIORITY ONE EMS. I hereby authorize PRIORITY ONE EMS to investigate my employment history with current and/or former employers and to make any further investigation deemed necessary in connection with my application for employment, including a criminal history check, driving history check, child abuse clearance check, and other such inquiries. I release PRIORITY ONE EMS and all informants from all liability resulting from such inquiries. I waive all rights to see or review the information so furnished. I certify that I am not now, nor have I ever been excluded from any state or federal health care program. I further understand that if it is determined that I was so excluded, my employment with PRIORITY ONE EMS may be terminated.
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