Scott Township Fire & EMS 2023 Civilian Paramedic ApplicationPlease enable JavaScript in your browser to complete this form. - Step 1 of 5Name *FirstMiddleLast*** MIDDLE NAME IS REQUIRED FOR BACKGROUND CHECK PURPOSES ***Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Home Phone *Other PhoneDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Social Security # *Driver's License # *Are you age 18 or older? *YesNoAre you a citizen of the United States? *YesNoIf no, are you authorized to work in the U.S?YesNoHave you ever been convicted of a felony? *YesNoIf yes, explain:Have you ever worked for Scott Township Fire & EMS? *YesNoWhen did you work for us?NextEducationHighest Level of Education? *Some High SchoolGEDHigh School DiplomaSome CollegeAssociate's DegreeBachelor's DegreeMaster's DegreeHigh SchoolAddressFromToCollegeDegreeAddressFromTo PreviousNextMilitary ServiceHave you ever served or are you currently serving in the U.S. Military? *YesNoBranchFromToRank At DischargeType of DischargeIf Other Than Honorable, ExplainPreviousNextPrevious EmploymentCompanyAddressPhoneSupervisorJob TitleResponsibilitiesCurrently employed here?YesNoStart DateEnd DateReason For LeavingMay we contact your previous supervisor for a reference?YesNoAdd another employer?YesNoCompanyPhoneAddressSupervisorJob TitleResponsibilitiesCurrently employed here?YesNoStart DateEnd DateReason For LeavingMay we contact your previous supervisor for a reference?YesNoAdd another employer?YesNoCompanyPhoneAddressSupervisorJob TitleResponsibilitiesCurrently employed here?YesNoStart DateEnd DateReason For LeavingMay we contact your previous supervisor for a reference?YesNoPreviousNextCurrent Certification / Licenses *** ALL REQUIRED LICENSES AND CERTIFICATIONS MUST BE SUBMITTED WITH APPLICATION TO ENABLE PROCESSING.*** Please call with any certification questions prior to form submission. FF/EMT Minimum Required List: - Driver's License - EMT Certification - AHA BLS Provider CPR Certification - FF I/II and HAZMAT Ops Certificates FF/Paramedic Minimum Required List: - Driver's License - Paramedic License - AHA BLS Provider CPR Certification - ACLS, PALS, ITLS or PHTLSDriver's License Click or drag files to this area to upload.You can upload up to 2 files. EMT Certification or Paramedic License Click or drag files to this area to upload.You can upload up to 10 files. Additional Certifications Click or drag files to this area to upload.You can upload up to 10 files. CPR, ACLS, PALS, ITLS/PHTLSOther Specialized Training / Classes Relevant To Desired PositionTitle of Special CourseSkills Aquired / Credits EarnedCompany / Sponsor / SchoolAdd Another?Title of Special CourseSkills Aquired / Credits EarnedCompany / Sponsor / SchoolAdd Another?Title of Special CourseSkills Aquired / Credits EarnedCompany / Sponsor / SchoolPreviousPhoneSubmit
