Employment Application

Name(Required)

First Last

Email(Required)

Phone

Drivers License #

Drivers License State

State

Address

Street Address City State ZIP Code

Are you eligible for employment in the USA?

(if yes, verification will be required)

Yes

No

Position you are applying for:

Current State of Michigan/National Registry License Level:

Have you previously been employed by White Lake Ambulance Authority?

Yes

No

If Yes, when?

If your application is considered favorably, on what date will you be available for work?

Are there any other experiences, skills, or qualifications, which will be of special benefit in the job for which you are applying?

Applicants should not list any information that Federal and/or State law precludes obtaining in the pre-employment stage

Education

School

School Location

City State

Degree/Diploma & Field of Interest

School

School Location

City State

Degree/Diploma & Field of Interest

Past Employment

Business Name

Supervisor Name

Business Address

Street Address City State ZIP Code

From

To

Beginning Salary

Ending Salary

Business Name

Supervisor Name

Business Address

Street Address City State ZIP Code

From

To

Beginning Salary

Ending Salary

I hereby give my permission to contact employers listed above concerning my prior experience and to check my driving record.

Yes

3 Personal References

Not former employes or relatives

Name & Occupation

Phone

Years Known

Address

Street Address City State ZIP Code

Name & Occupation

Phone

Years Known

Address

Street Address City State ZIP Code

Name & Occupation

Phone

Years Known

Address

Street Address City State ZIP Code

Phone

This field is for validation purposes and should be left unchanged.

Application for Employment

Education

Past Employment

3 Personal References