Cetronia - Health on Wheels
Caas
Application for Employment


Application for Employment
 
EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER
Cetronia Ambulance Corps recognizes that all practices are entitled to equal employment opportunities, and in its recruitment, training and compensation practices, the best qualified individual, based on organizational requirements, shall be selected, without regard to race, creed, color, sex, age, or national origin, as well as mental and physical handicaps that do not interfere with job performance.
 
***Important Note: Cetronia Ambulance Corps is a drug and tobacco free work environment. As a result, candidates selected for employment may be subject to a drug screen test which includes nicotine. ***
 
Today's Date:
Status request for application:
Name (Last, First, Middle):
Telephone number:
Email Address:
Street address:
City:
State:
Zip:
Position desired:
Who referred you?
When can you start?
What time is best to be contacted?
Have you ever been convicted of a felony?
If so explain:  
a conviction record will not necessarily be a bar to membership or employment. factors such as age and time of offense, seriousness, and nature of violation and rehabilitation will be taken into account.
 
 
In case of an emergency notify?
Name:
Address:
Phone:
 
 
Education
  School Name School Major School Years School Degree/Diploma
High School
Business School
College
Other
         
         
Military
From:
To:
Branch:  
Intro Rank:
Separation Rank:
Current Military affiliation:
 
 
Emergency Service
  Name Address Involvement Phone
1
2
3
         
         
References
  Name Occupation Years Known Address Phone
1
2
3
 
 
Availability
  0000-0600 0600-1200 1200-1800 1800-0000
Sun
Mon
Tues
Weds
Thurs
Fri
Sat
 
 
Employment History
Name:
From:
To:
 
Address:
Phone:
Supervisor:
Title:
Responsibilities:    
Reason for leaving:
 
May we contact?  
     
     
Name:
From:
To:
Address:
Phone:
Supervisor:
Title:
Responsibilities:    
Reason for leaving:
 
May we contact?  
     
     
Name:
From:
To:
Address:
Phone:
Supervisor:
Title:
Responsibilities:    
Reason for leaving:
 
May we contact?  
 
 
Name:
From:
To:
Address:
Phone:
Supervisor:
Title:
Responsibilities:    
Reason for leaving:
 
May we contact?  
 
 
Other

Have you ever worked for any of the above under another name?

If so please list employer(s) :
Other skills:        
Other goals:
Special Training
  Course Date State Training Certificate NOS
1
2
3
4
5
6
         
         
READ THOROGHLY BEFORE SIGNING

BY TYPING NAME BELOW I certify that all data provided on this application is true and accurate. I understand that it will be carefully checked and that willful misrepresentation or omission of facts on my part may be justification for separation from the Organization's services, if employed or accepted into membership. I authorize you or my former employers or references to furnish any information concerning my personal background or employment record and I hereby release all such persons from any liability on account of having furnished this information. I understand that if employment is obtained under this application, the organization does not guarantee employment for a fixed term. I understand that any offer of employment is contingent upon satisfactory completion of a Cetronia Ambulance Corps administered medical examination.

Signature: Date:

Enter the code you see above: (Case Sensitive)