BALBOA AMBULANCE
APPLICATION FOR EMPLOYMENT

Balboa Ambulance is an Equal Opportunity Employer and considers applications for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, citizenship or any other characteristic protected by law.

BALBOA AMBULANCE IS A DRUG-FREE WORKPLACE

RESUME
You can upload your resume in Word or PDF format if you want. Max file size: 1 MB
PERSONAL INFORMATION
Name
Social Security Number will be required
at the time of the interview.
Email
Address
City
State
Zip Code
Home Number
Cell Number
Are you at least 18 years of age?
Hours requested
Position(s) Applying For
Salary Desired
How did you find out about this position?
Can you present evidence of your legal right to work in the U.S.?
Would you have reliable means of transportation to and from work?
Are you currently employed?
Are you available to work weekends?
Are you available to work overtime?
PERFORMANCE OF ESSENTIAL JOB FUNCTIONS
Due to the physical demands of this job, you must be able to perform the following tasks:
- Lifting patients on or off a stretcher,
- Climbing stairs,
- Moving and shifting of patients to and from chairs, beds, etc.,
- Carrying patients up/down stairs, over obstacles, and our of vehicles,
- Carrying heavy equipment to and from incident scenes,
- Lifting tasks that resemble squats, pushes, presses, and curls.

***Special Note:  It is not uncommon to have heavy patients (in excess of 400 pounds) and/or need to do a significant amount of lifting on a daily basis.  For this reason, it is crucial that all EMT’s maintain a level of strength training and endurance to provide safe patient movements and transfers as well as maintain a healthy body for the duration of the EMT’s career.

Are you able to perform the above Essential Job Functions for which you are applying, with or without reasonable accommodations?


If no, describe the functions that cannot be performed:
EDUCATION
SCHOOL LEVEL NAME AND LOCATION OF SCHOOL #OF YEARS
COMPLETED
DID YOU
GRADUATE?
DEGREE/
DIPLOMA
HIGH SCHOOL
COLLEGE/
UNIVERSITY
VOCATIONAL/
BUSINESS
OTHER
FORMER EMPLOYERS
List all of your employers over the past 7 years, starting with the most recent.
[-]   Employer 1
Name of Present or Last Employer
Address
City
State
Zip
Start Date
End Date
Description of Job Duties
Starting Wage
Ending Wage
Reason for Leaving
Supervisor's Name
May we contact?
[-]   Employer 2
Name of Present or Last Employer
Address
City
State
Zip
Start Date
End Date
Description of Job Duties
Starting Wage
Ending Wage
Reason for Leaving
Supervisor's Name
May we contact?
[+]   Employer 3
[+]   Employer 4
[+]   Employer 5

OFFENSES
Have you ever been convicted, pled guilty, or no contest to a felony or misdemeanor, including a DUI/DWI or similar offense, had any moving violations, or had your license revoked or suspended?


If yes, state the nature of the crime(s), when and where convicted, and disposition of the case(s).

Convictions will not necessarily disqualify an applicant for employment.
CERTIFICATIONS
CERTIFICATION NAME CERTIFICATION NUMBER EXPIRATION DATE INSTRUCTING AGENCY
CPR
EMT CERT
NATIONAL CERT
DRIVERS LICENSE
PROFESSIONAL REFERENCES
NAME TITLE COMPANY TELEPHONE YEARS
ASSOCIATED
AVAILABILITY
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Comments
EMPLOYMENT APPLICATION ADDENDUM
Have you ever been or are you currently excluded, suspended, debarred or otherwise deemed ineligible to participate governmental healthcare, procurement, or other programs?


If yes, list ALL such exclusions, suspensions, or debarments including applicable governmental agency, action date, and your address at the time of the action.
AUTHORIZATIONS
Please read carefully, check and authorize each paragraph:

 TRUTHFULNESS OF APPLICATION:  I certify that the facts set forth in this employment application are true and complete to the best of my knowledge.  I understand that the misrepresentation or omission of material facts may result in termination of my employment.

 AUTHORIZATION TO INVESTIGATE:  I authorize any of the persons or organizations referenced in this application to give Balboa Ambulance any and all information concerning my previous employment, education, or any other information they might have, with regard to any of the subjects covered by this application, and release all such parties from the liability for any damage that may result from furnished such information.  I authorize the Company to request and receive such information.

 AT-WILL RELATIONSHIP:  I understand and agree that if I am offered employment with Balboa Ambulance it will be on an “at-will” basis.  This means that either I or Balboa Ambulance may terminate the employment relationship at any time for any reason, with or without cause.  I further understand that the “at-will” nature of my employment with Balboa Ambulance is an aspect of employment that cannot be modified or changed, except by a written agreement signed by the chief executive officer of Balboa Ambulance.  I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Balboa Ambulance.

 SEARCH OF PUBLIC RECORDS:  Should a search of public records – including records of an arrest, indictment, conviction, civil judicial action, tax, lien, or outstanding judgment – be conducted by internal personnel employed by Balboa Ambulance, I am entitled to copies of any such public records obtained by Balboa Ambulance unless I initial below.  If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below. 

 I waive receipt of a copy of any public record described in the above paragraph.