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Personal Information


Present Address:


Personal Information:

Employment Information

Days/Hours Available to Work:
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Can you work nights?

Can you work holidays?

Employment Desired:
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Education & Other Information
Type of School Name of School Location
(Complete mailing address)
No. of Years
Major & Degree
High School  
Bus. or Trade School
Professional School

Have you ever been convicted of a crime?

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, senetence(s) imposed, and type(s) of rehabilitation.

Do you have a driver's license?

Driver's License Information


Have you had any accidents during the past three years?

Have you had any moving violations during the past three years?

Please list two references other than relatives or previous employers

An application form sometimes make it difficult for an individual to adequately summarize a complete background. Use the space below to add any additional information necessary to describe your full qualifications for the specific position for which you are applying.


Have you ever been in the armed forces?

Are you now a member of the National Guard?

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name.


Employment Dates


Employment Dates


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Please list the following certifications

Application Form Waiver

Please read carefully.

In exchange for the consideration of my job appication by Ironbound Ambulance Squad (hereinafter called "the Company"), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, standard operating procedures, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Ironbound Ambulance Squad, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President of the Company. Both the undersigned and Ironbound Ambulance Squad may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their policies and procedures and such changes may include reduction in benefits.

I authorize the investigation of all statements contained in this application. I understand that the misrepresentation or omission o facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as random testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successfull passing of job-related physical examinations.

I understand that (1) the Company has a pre-employment background check policy; (2) consent to and compliance with such policy is a condition of my employment. I further understand that employment will be based on the successful passing of the background check.

I understand that, in connection with the routine processing of your employment application, the Company may request form a consumer reporting agency an investigate consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of one hundred eighty (180) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.