Employment Application

We appreciate the opportunity to review your qualifications for employment with this company. So that we can thoroughly consider your special skills and abilities, we would appreciate your completion of our Employment Application. Thank You Beauport Ambulance Service, Inc. is an equal opportunity employer. All qualifications will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, ancestry, national origin, age, disability, handicap, genetics or veteran status. Please answer all the questions as completely as possible. If you feel any questions may violate your rights, please do not answer. Print your answers clearly.
  • Section 1 - General Information

    Note: If you are hired, you will be required to submit proof of legal right to work in the United States.
  • Section 2 - Education and Specialized

  • Section 3 - Chair Car and EMS Applicants

    All applicants for employment that are scheduled for an interview must provide a current driving record obtained from the Registry of Motor Vehicles, copy of Drivers license, NIMS 100, 200, 700, OEMS cards and HCP-CPR card.
  • EMT-B
  • EMT-I
  • PARAMEDIC
  • TOTAL YEARS
  • Section 4 - References

    List below three persons NOT related to you and NOT personal friends whom you have known at least one year and who can give a thorough assessment of your job performance and skills.
  • Section 5 - Computer Software/Radio Skills

    Please check all that apply.
  • Section 6

    Please check all that apply.
  • Section 7 - Employment History

    List below the names of your last three employers (you may list volunteer positions as well as paid positions). List present employer or most recent employer first. You may use the reverse side of this application to provide further information if you wish.
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  • Section 8

    Please READ CAREFULLY before signing. Note: Beauport Ambulance Service, Inc. is committed to providing a ‘Drug Free’ working environment and all employees are subject to random drug screening. Beauport Ambulance Service, Inc. is an Equal Opportunity Employer. I certify that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I hereby authorize, without reservation, any law enforcement agency, administrator, state agency, institution, information service bureau, employer or insurance company contacted by Beauport Ambulance or its agent to furnish information regarding the above. I understand that the use, purchase, transfer, possession or sale or being under the influence of illegal drugs or controlled substances while on Beauport Ambulances premises, the premises of any Beauport Ambulance worksite, or while engaged in Beauport Ambulance business is strictly prohibited and is grounds for immediate discharge. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment, as required by Beauport Ambulance. I understand that the federal regulations require that my employment be conditioned upon presentation of documents at the time of hire which verify my identity and eligibility to work in the U.S. ( i.e. Passport, certificate of U.S. Citizenship or naturalization, alien registration card, drivers license, U.S. military card, social security card, birth certificate, or other U.S. employment authorization.) I further acknowledge that a fax or photographic copy shall be valid as the original. This release includes all state and federal agencies. Unless otherwise noted, I authorize this Company or its agent to investigate and/or verify all information in this application, including contacting all persons, schools, current employer (if applicable), previous employers and other individuals and entities named herein (and those named on accompanying resume, if any). I hereby authorize my former employers and other third parties named on this application to release information pertaining to my work record, habits and performances. In doing so, I hereby release them and this Company and its agents from all liability which may flow from the release of such information. Should my employment terminate, it is understood that Beauport Ambulance may supply my complete record in response to any bona fide request, and I hereby release Beauport Ambulance and any of its staff from any liability and responsibility in connection therewith. I agree, in the event Beauport Ambulance should employee me, either party for any reason or no reason may terminate my employment at any time. I further agree that this agreement regarding my status as an employee “at will” cannot be changed except in the form of a written agreement signed by the Chief Executive Officer, Chief Financial Officer or Human Resources. I agree that if I become employed with Beauport Ambulance and thereafter, I shall not, without the prior consent of Beauport Ambulance, issue any press release or make any public announcement with respect to my employment with Beauport Ambulance or its clients. If I am contacted by the press regarding Beauport Ambulance or client-related matter, I understand that I am to refer the inquiry to the Director. Following the date hereof and regardless of any dispute that may arise in the future, I shall not, disparage, criticize or make statements which are negative, detrimental or injurious to Beauport Ambulance or its clients, officers or employees. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.