NEW BRITAIN EMS APPLICATION FOR EMPLOYMENT

 

IDENTIFICATION
LAST NAME:
  		FIRST:
  		MIDDLE:
  		SSN:
 
PRESENT ADDRESS: STREET & NUMBER
  		CITY
  		STATE
 		ZIP
  		TELEPHONE
 
U.S. CITIZEN?
 Yes  No 		TYPE VISA:
  		VISA NUMBER:
 
 Check this box if you are over 21 DRIVERS LICENSE NUMBER:
  		STATE:
  		EXPIRATION:
 
IN CASE OF EMERGENCY PLEASE NOTIFY: NAME
  		ADDRESS
  		PHONE
 
DO YOU HAVE RELATIVES WORKING AT NEW BRITAIN EMS?
 Yes  No 		NAME AND RELATIONSHIP
 
EMAIL ADDRESS:
  		BUSINESS PHONE:
 
JOB STATUS
POSITION OR TYPE OF WORK APPLYING FOR:
1.  
2.  
 
SEEKING
 Full Time  Part Time
 PRN
SHIFT WILLING TO WORK
 8 Hr.  12 Hr.
 Any
AVAILABLE TO WORK WEEKENDS?

 Yes  No

 
CURRENTLY EMPLOYED?

 Yes  No 		CAN WE CONTACT YOUR PRESENT EMPLOYER?

 Yes  No 		PREVIOUSLY EMPLOYED BY
NEW BRITAIN EMS?
 Yes  No 		DATE AVAILABLE FOR WORK

 
U.S. MILITARY
BRANCH OF U.S. SERVICE
  		DATE ENTERED
 
DATE DISCHARGED
 
RANK AT DISCHARGE
 
NATURE OF DUTIES AND SPECIAL TRAINING RECEIVED
 
TRAINING
Please indicate any educational, vocational, on-the-job, or any other training you have received which will aid us in placing you in the position that best meets your qualifications and/or in determining your qualifications for a position for which you desire to be considered.
HIGH SCHOOL         NAME AND LOCATION
  		DEGREE AND/OR TRAINING RCVD
  		MAJOR / MINOR
 
COLLEGE TRAINING
 
 
 
GRADUATE SCHOOL
 
 
 
OTHER SCHOOLS OR SPECIAL TRAINING, INCLUDING LANGUAGES OR OTHER SKILLS
 
TYPING SPEED
  WPM 		SHORTHAND SPEED
  WPM 		OFFICE MACHINES OR OTHER SPECIAL EQUIPMENT USED
 
NATIONAL REGISTRY ID: (MUST BE COMPLETED)
Number:  		Registered Since?
  		EXPIRATION DATE
 
GENERAL
HAVE YOU EVER BEEN CONVICTED OF A FELONY?  Yes  No
EXPLAIN (CONVICTION WILL NOT NECESSARILY BAR EMPLOYMENT)
WORK EXPERIENCE
Start with your present or last position and work back accounting for all periods of employment.
PRESENT / LAST EMPLOYER
NAME OF EMPLOYER
  		TYPE OF BUSINESS
  		ADDRESS
 
STARTED MM/YY
  		LEFT MM/YY
  		STARTING PAY
  		FINAL PAY
  		NAME AND TITLE OF SUPERVISOR
  		TELEPHONE
 
JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES
  		REASON FOR LEAVING
 
PREVIOUS EMPLOYER
NAME OF EMPLOYER
  		TYPE OF BUSINESS
  		ADDRESS
 
STARTED MM/YY
  		LEFT MM/YY
  		STARTING PAY
  		FINAL PAY
  		NAME AND TITLE OF SUPERVISOR
  		TELEPHONE
 
JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES
  		REASON FOR LEAVING
 
PREVIOUS EMPLOYER
NAME OF EMPLOYER
  		TYPE OF BUSINESS
  		ADDRESS
 
STARTED MM/YY
  		LEFT MM/YY
  		STARTING PAY
  		FINAL PAY
  		NAME AND TITLE OF SUPERVISOR
  		TELEPHONE
 
JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES
  		REASON FOR LEAVING
 
PREVIOUS EMPLOYER
NAME OF EMPLOYER
  		TYPE OF BUSINESS
  		ADDRESS
 
STARTED MM/YY
  		LEFT MM/YY
  		STARTING PAY
  		FINAL PAY
  		NAME AND TITLE OF SUPERVISOR
  		TELEPHONE
 
JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES
  		REASON FOR LEAVING
 
COMMENTS