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  • Medexpress Ambulance Service, Inc.

  • Section A: Personal Data

  • Let's get started with your email address!
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  • Section B: Desired Position

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  • Section C: State and National Licenses

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  • Section D: Education

  • List each formal educational institution that you have attended. Start with your High School and work toward the most recent. You may list up to ten. Click the + button to add a new row.
    School or College NameCourse of StudyGraduate (Y/N)Year and DegreeZip Code 
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  • Section E: Work History

  • List each place of employment that you have held (NOT including self-employment). Please begin with the oldest and work toward the most recent. You may list up to ten. Click the + button to add a new row.
    EmployerCityZipPhoneSupervisorJob TitleStart & End Date 
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  • Section F: Specialized Skills

  • Total years of commercial driving experience for each class.
    Class AClass BClass CClass D
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  • Section G: Additional Information

  • Date Format: MM slash DD slash YYYY
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  • Section H: Attachments & Resumes

  • Attachments

    Please provide copies of all that apply:
    • Class D Drivers License
    • State Registry Card
    • Defensive Driving Certs
    • PALS
    • Social Security Card
    • AHA BCLS "C" Card
    • Hazmat Certifications
    • PHTLS
    • National Registry Card
    • AHA ACLS Card
    • Board of Examiners Certificate
    • MVR
  • Size Limit: 128MB
    Drop files here or
    Accepted file types: jpeg, jpg, png, pdf, doc, docx, rtf.
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  • Size Limit: 128MB.
    Accepted file types: pdf, doc, docx, rtf.
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  • Signature

    Medexpress Ambulance Service is an Equal Opportunity Employer. We consider applicants without regard for race, color, religion, creed, sex, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

    I voluntarily give this institution the right to make a thorough investigation of my past employment and activities. I consent to take the physical examination, and such future physical examinations as may be by this institution at such times and places as the institution shall designate. I agree to take a pre-employment drug test and will participate in future random drug screening as by this institution.

    Any questions or comments, please contact the Director of Human Resources at 1-800-259-9771

    NOTE: The completion of this form is a request for employment information but is not an application for employment.

    By signing below, I confirm that the information contained above is true and correct to the best of my knowledge.

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