Employment

Hanover Township Community AmbulanceAssociationInc. considers all applicants for all positions, in accordance with Title VII of the Civil Rights Acts of 1964, as amended, and the Americans With Disabilities Act of 1990, and Age Discrimination in Employment Act of 1967, as amended, which prohibits discrimination in the recruitment, selection and hiring of employee

Position Applied For(Required)

Date of Application(Required)

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Telephone Number(s)(Required)

Social Security #

Email(Required)

Date of Birth(Required)

Education

High School

How many years did you complete?

Did you graduate?

Undergraduate School Name

How many years did you complete?

Did you graduate?

What field of study/degree?

Graduate School Name

How many years did you complete?

Did you graduate?

What field of study/degree?

Certifications

Please list and supply copies of the following Certifications, with expiration and completion dates if applicable:

CPR(Required)

CPR - Expiration or Completion Date

EVOC(Required)

EVOC - Expiration or Completion Date

ACLS(Required)

ACLS - Expiration or Completion Date

PALS(Required)

PALS - Expiration or Completion Date

BTLS(Required)

BTLS - Expiration or Completion Date

PHTLS(Required)

PHTLS - Expiration or Completion Date

Please any other Certifications not listed above:

Certification Name

Exp/Comp Date

Click on the "+" icon to add more

Past Employment

Click on the "+" icon to add more

Employment Details

Employer Name

Address

Phone #

Employment

Salary

Contact Person

May we contact your past employment?(Required)

Driver’s Information

Please complete the following information as it appears on your driver’s License.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Driver’s License Number

State

Expiry

What Class license

(standard is class 1 or C)

Do you have any restrictions on your license?

If yes, indicate which restrictions(Required)

The following questions are in direct relationship to the operation of an emergency vehicle, as required under the rules and regulations of Act 45 of 1985, Title 28; Health and Safety.

Have you ever completed a PA Emergency Vehicle Operators Course?(Required)

If Yes, please give place(Required)

and date(Required)

Have you ever been convicted within the last 4 years of driving under the influence of alcohol or drugs?(Required)

If yes please give date(Required)

Have you ever been convicted of reckless driving within the past 2 years?(Required)

If yes, please give date(Required)

Have you ever had your driver’s license suspended under the point system?(Required)

If yes, please give date(Required)

Date(Required)

Criminal History Record

In Accordance with Act 45 of the Pennsylvania, and Hanover Township Community Ambulance Association Inc Operating Procedures please answer the following:

Have you ever been arrested and/or convicted of a misdemeanor or felony?(Required)

(A conviction offense is not a bar from employment. Each Case is considered on its merits.)

Charges

Convicted (Yes/No/Pending)

Arrested (Yes/No)

Date(s)

Place(s)

An original Pennsylvania State Police “Request for Criminal Record Check” (sp 4-164(3-91))

Max. file size: 300 MB.

An original Pennsylvania States Police “Criminal Record Attachment” (sp 4-1376)

Max. file size: 300 MB.

A notarized copy of relevant court documents showing dates, outcomes and conditions set by the court

Max. file size: 300 MB.

All Applicants

Date

References

Name

Address

Phone Number

Click on the "+" icon to add more

Hanover Township Community Ambulance Association Inc. Medic 9

Education

Certifications

Past Employment

Driver’s Information

Criminal History Record

All Applicants

References

CONTACT US TODAY

EMAIL US