Apply Today Interested in working with us?Fill out the application to get started. Call Vitalogy Now Job Application Form First Name Last Name Phone Email Address How did you hear about us?How did you hear about us?Web SearchGoogleSocial MediaWord of MouthOther What days are you available?What days are you available?MonTueWedThurFriSatSun Address, City, State, Zip Date of Application Employment Positions: What position are you interested in? EMT, AEMT, PARAMEDIC, or OTHER? (if 'other' please specify) What hours or shifts are you available to work? Are you available to work overtime? (Y or N) On what date are you available to start? Personal Information: Are you 18 or older?Are you 18 or older?YesNo Are you a U.S. Citizen and approved to work in the United States?Are you a U.S. Citizen and approved to work in the United States?YesNo Do you consent to a mandetory controled substance test?Do you consent to a mandetory controled substance test?YesNo Do you have an conditions in which you require special job accomodations?Do you have an conditions in which you require special job accomodations?YesNo If yes, please describe accommodations below? Have you ever been convicted of a criminal offense (felony or misdemeanor)?Have you ever been convicted of a criminal offense (felony or misdemeanor)?YesNo If yes, please state the nature of the crime(s), when and where convicted, and disposition of the case*: *Note: no applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) Job Skills/Qualifications: Please list below the skills and qualifications you possess for the position for which you are applying:* *Note: Vitalogy EMS LLC complies with ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.) Education & Training: High School: Location (City, State), Year Graduated, Degree Earned College/University: Location (City, State), Year Graudated, Degree(s) Earned Vocational School: Location (City, State), Year Graduated, Degree(s) Earned - list any emergency medical servies certifications or classes applicable to the job you are applying for. Military: Are you currently a member of the United States Armed Forces?Are you currently a member of the United States Armed Forces?YesNo If yes, what branch? Are you a veteran or former member of the United States Armed Forces?Are you a veteran or former member of the United States Armed Forces?YesNo If yes, under what branch did you serve? How many years did you serve? What was your military rank when discharged? What military skills do you possess that would be an asset for this position? Previous Employment Information: List your last 3 Please list your Employer's Name, Supervisor's Name, Employer Address, Employer Telephone and Dates of Employent. What was your reason for leaving each position? Employer 1 Employer 2 Employer 3 Professional References: Please provide 3 personal/professional references: Please list your Reference's names, relationship to you, and contact information. Reference 1 Reference 2 Reference 3 Additional Information: Please attach copies of your NREMT certification, Montana State EMS license, and CPR provider card. New FieldSelect FilesNo Files ChosenAccepted file types: .jpg, .png, .heic, .pdf. Max. file size: 1 MB What states have you worked in in the past? Has your EMS license ever been suspended or revoked? If so, when and in what state? Please explain the situation. Do you currently work for any other EMS agency or medical center? If yes, which agency or organization? In the past five years have you been convicted of a DUI, careless driving or reckless driving offense? If yes, please explain. At-Will Employment: The relationship between you and the Vitalogy EMS LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Vitalogy EMS LLC. No representative of Vitalogy EMS LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that you reemployment is "at will," and that you acknowledge that no oral or written statements regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President. Resume Upload: New FieldSelect FilesNo Files ChosenAccepted file types: .jpg, .png, .heic, .pdf. Max. file size: 1 MB Signature:Your SignatureSaveClear Submit Application
