Paramedic - Part Time
Rock Township Ambulance District
Field Operations
Rock Township Ambulance District
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Part-Time
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Application Specific Questions
I have provided all relevant work experience above which includes prior agency, dates employed, salary, and reason for leaving.
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Missouri EMS Provider License Number
NREMT Number - if none, type NA.
How many years of prehospital experience do you have?
Drivers License Number
Drivers License Expiration Date
BLS expiration date
ACLS expiration date
List any additional certifications you currently hold e.g., CP, PALS, NRP, PHTLS, AMLS, EPC, CEVO, FP-C, CCP-C, etc.
How many hours can you work weekly?
Do you certify that you are a U.S. Citizen, permanent resident, or a foreign national with legal authorization to work in the United States?
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Have you ever been previously employed by Rock Township Ambulance District?
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No
If YES, provide dates.
Has your EMT or Paramedic license ever been suspended or revoked or received sanctions for any reason?
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No
If YES, please explain.
Have you ever been arrested for a misdemeanor or felony?
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No
If YES, please explain.
Have you ever been convicted of, or entered a plea of guilty or no contest, or had a withheld judgement to a misdemeanor or felony?
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No
If YES, please explain.
Has your drivers license ever been suspended or revoked for any reason?
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No
If YES, please explain.
Have you had any motor vehicle collisions during the past three years?
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No
If YES, please explain.
Have you had any moving traffic violations during the past three years?
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No
If YES, please explain.
I agree to the conditions and information provided in the position profile acknowledgement, authorization, and release.
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