24 Hour Emergency Services Emergency Line CAREERS EMPLOYMENT / JOB APPLICATION PERSONAL INFORMATIONFirst Name *Last NameAddress *Phone *Email *Social Security Number(SSN)Date AvailableDesired Pay $HourSalaryPosition Applied For *Employment Desired *Full TimePart TimeSeasonalPERSONAL INFORMATIONAre you Legally Eligible to work in the US? *YesNoHave you ever worked for this Employer? *YesNoIf yes write Start Date and End DateEDUCATIONHigh SchoolGraduateYesNoDiplomaCollegeGraduateYesNoDegreeOtherOthersAddressPREVIOUS EMPLOYMENTEmployersEmployerEmailPhoneJob TitleResponsibiltiesDates of EmploymentReason for LeavingREFERENCESReferencesFull nameRelationshipCompanyTitleEmailPhoneAre you Veteran? *YesNoMILITARY SERVICESBranchRank at DischargeDates of ServiceBACKGROUND CHECK CONSENTIf asked, are you willing to consent to a Background Check?YesNoPlease complete each section EVEN IF you decide to attach a resumeChoose FileNo file chosenDelete uploaded fileDISCLAIMER Employer provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself. I affirm all the above statements are true *YesNoDatePrint NameSubmit