Join our team today!You’ll make a lifetime of memories! Online Application Click Here to Open our Online Application Online Application Name * First Name Last Name Date of Birth * MM DD YYYY Current Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Years at Current Address * Driver's License Number * Phone * Country (###) ### #### Social Security Number * Email * What position(s) are you interested in? Junior Member (Applicants Age 14-17) Attendant Emergency Vehicle Operator (Driver) Emergency Medical Technician Paramedic Board Member Other or "I'm not sure" Have you ever had a driving infraction? * Have you ever been accused or convicted of a crime other than you have listed above? * Are you currently or have you ever been investigated for any action, or failure to act as a healthcare provider? * Have you ever had any certification revoked or suspended? * Are you currently or have you ever been a member or employee of an ambulance service, law enforcement agency or fire department? (If so, please provide the name of the organization(s), dates of membership and your status within the agency.) * Please provide three references, including their full name, employer, position at that employer, and phone number: * Additional Information By clicking "SUBMIT", I understand that this application is for membership at Warrensburg Emergency Medical Services, Inc. I authorize said corporation to obtain background information including but not limited to criminal background checks, medical records, education records and verification of employment. I understand that this information will be safeguarded from unauthorized disclosure, and I attest to the truthfulness and accuracy of the information that I have provided on this application for membership or employment. Your application has been received. Thank you for applying! We will be in touch with you soon!
