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Paramedic and EMT Employment Application

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This field is for validation purposes and should be left unchanged.
I applying for a job as
- An EMT
- A Paramedic
Schedule Type
What kind of schedule are you interested in working? Check all that apply.
- Per Diem
- Full Time
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Business Phone
Email*
Personal Information
If you are applying for an ambulance position, are you at least 21 years of age?*
(SSC Insurance requires all ambulance personnel to be at least 21)
- Yes
- No
Can you provide proof of citizenship?*
If hired, can you provide proof of U.S. Citizenship or proof of your legal right to live and work in the United States of America
- Yes
- No
Driver's License Info
Status of License*
Do you have a valid California Drivers License?
- Yes
- No
Ambulance Driver's License?*
Do you have a valid California Ambulance Drivers License?
- Yes
- No
Employment Status?*
Are you currently employed?
- Yes
- No
Education, Training, and Experience
High School
Please include the city and state.
Years of High School
Graduated High School?
- Yes
College
Please include the city and state.
Years of College
Graduated College?
- Yes
College Subject Studied
College Degree
Vocational School
Please include the city and state.
Years of Vocational School
Graduated Vocational School?
- Yes
Vocational Subject Studied
Vocational Degree
Health Care School
Please include the city and state.
Years of Health Care School
Graduated From This Health Care School?
- Yes
Healthcare Subject Studied
Healtcare School Degree
Special Qualifications
Do you have any other experience, training, qualifications or skills, which you feel make you especially suited for work at Sequoia Safety Council? If so, explain.
License / Certificate Information
Answer the following questions if you are applying for a professional position
Are you licensed or certified for the job applied for?
- Yes
- No
Name of license or certification
Issuing State
License or Certificate Number
License History
If your license has ever been revoked, please explain.
Employment History
List below all past and present employment starting with your most recent employer (last 10 years). Account for all periods of unemployment.
Employer Name 01
Type of Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Supervisor's Name
Your Position
Your Duties
Date of Employment
Please include both the start and end dates of this employment.
Reason for Leaving
Employer Name 02
Type of Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Supervisor's Name
Your Position
Your Duties
Date of Employment
Please include both the start and end dates of this employment.
Reason for Leaving
Employer Name 03
Type of Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Supervisor's Name
Your Position
Your Duties
Date of Employment
Please include both the start and end dates of this employment.
Reason for Leaving
Employer Name 04
Type of Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Supervisor's Name
Your Position
Your Duties
Date of Employment
Please include both the start and end dates of this employment.
Reason for Leaving
Military Service
Specialized Skills
If you've obtained any specialized skills or abilities as the result of military service, please explain here.
References
List below three (3) persons not related to you who have knowledge of your work performance within the last three years. Please do not include any previous listed supervisors.
Name
Occupation
Address
Years Acquainted
Phone
Cell Number
Name
Occupation
Address
Years Acquainted
Phone
Cell Number
Name
Occupation
Address
Years Acquainted
Phone
Cell Number
Upload Resume
File
Accepted file types: pdf, Max. file size: 2 MB.
Letters of Recommendation
You may upload up to three Letters of Recommendation at once here.
Drop files here or

Accepted file types: pdf, Max. file size: 5 MB, Max. files: 3.
Legal Digital Signature
When you check "I Agree" below, fill in your three-letter initial, and submit the form, the system date stamp is added to create a valid digital signature in our database.
All Answers Are Truthful*
I warrant that all information submitted through this web form is true to the best of my knowledge.
- I agree
3-Letter Initials*
Please enter your 3-letter initials.
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Paramedic and EMT Employment Application

Personal Information

Driver's License Info

Education, Training, and Experience

License / Certificate Information

Employment History

Military Service

References

Upload Resume

Legal Digital Signature