Bartlesville Ambulance Employment Application

Bartlesville Ambulance Employment Application































    Must Obtain State License
  • Education History

  • Name of School
  • Address of School



  • Name of School
  • Address of School



  • Name of College
  • Address of College



  • Name of School
  • Address of School



  • General Information

  • Former Employers

    (List Below the Last Four Employers, Starting with Last One First)
  • From/To
  • From/To
  • From/To
  • From/To
  • References

    Give below the names of three persons not related to you, whom you have known at least one year
  • Authorization

  • “I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employment listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
    I also understand and agree that no repesentative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it si in the writing and signed by an authorized company representative.
    This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.