Application For Employment Note: Most fields require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview. Attach Resume:   All resumes must be in Microsoft Word or plain text format. Email:   Posistion Applied for:    Type of Work:   Full Time   PRN Shifts you can work:   Day   Evening   Night   12-hour shifts   24-hour shifts Can you work weekends:   Yes   No Can you rotate hours:   Yes   No Available to start work:   (mm/dd/yyyy) Salary Expected:   First Name:   Last Name:   Maiden:   MI:     Social:  -- Address:   City, St, Zip:      - Phone:  () - Cell Phone:  () - U.S. Citizen:   Yes   No If not, are you authorized to work in the U.S.?:   Yes    No Languages Spoken:   List relatives employed at CEMS:   Department:   In emergency notify: Name:   Phone:  () - Address:   City, St, Zip:      - Military Service:   Yes    No Service Date:   to  (mm/dd/yyyy) Have you ever been convicted of a felony?:   Yes    No If yes, explain briefly: Are you currently on deferred adjudication for a felony?:   Yes    No High School Name:     Last grade completed in school:   Graduate:   Yes    No City,State of school:   College University:   City,State of school:   Years Attended:   Graduate:   Yes    No Degree Type:   Associate   Bachelor   Master   PhD   Other (Please check all that apply.) Majors:    Post Graduate Courses:    Current Cerifications:   EMT    EMT-I    EMT-P    EMT-LP    BLS    ACLS  CCEMT-P    BTLS    PHTLS    PEPP    PALS  EVOC    EMD    None Previous Cerifications:   EMT    EMT-I    EMT-P    EMT-LP    EMD    BLS  Fire Fighter    Peace Officer Driver's License No:   State:  Previously Employed by CEMS, TMF, or GSMC:  Yes   No When:   Department:   Position:   Reason for Leaving: List All Present and Past Employment, Beginning With Most Recent - Include all jobs held in last five years Company Name:   Complete Address (w/ City, State, Zip):   Phone:  () - Salary:   Supervisor:   Start Date: (mm/dd/yyyy)   End Date: (mm/dd/yyyy)   Job Title:   Reason for Leaving: Company Name:   Complete Address (w/ City, State, Zip):   Phone:  () - Salary:   Supervisor:   Start Date: (mm/dd/yyyy)   End Date: (mm/dd/yyyy)   Job Title:   Reason for Leaving: Company Name:   Complete Address (w/ City, State, Zip):   Phone:  () - Salary:   Supervisor:   Start Date: (mm/dd/yyyy)   End Date: (mm/dd/yyyy)   Job Title:   Reason for Leaving: Company Name:   Complete Address (w/ City, State, Zip):   Phone:  () - Salary:   Supervisor:   Start Date: (mm/dd/yyyy)   End Date: (mm/dd/yyyy)   Job Title:   Reason for Leaving: Company Name:   Complete Address (w/ City, State, Zip):   Phone:  () - Salary:   Supervisor:   Start Date: (mm/dd/yyyy)   End Date: (mm/dd/yyyy)   Job Title:   Reason for Leaving: May we contact your present employer?   Yes    No May we contact your former employer?   Yes    No Personal References (Not Former Employers or Relatives - Complete addresses and phone numbers are required) Name: Occupation: Address: Day Phone Numbers:  () - Name: Occupation: Address: Day Phone Numbers:  () - Name: Occupation: Address: Day Phone Numbers:  () - Comments: