Our experience has shown that when the employees can deal openly and directly with supervisors and management the work environment becomes much more productive, and gives a feeling of family. Stoddard County Ambulance District believes that the work conditions, wages, and benefits offered at the District are competitive with those offered by other services in the area and in the industry.

The District provides for the full time employees: major medical, dental, and vision insurance as well as life insurance and retirement through Missouri LAGERS. There are many other benefits to employment with Stoddard County Ambulance as these are just a few. 

First and Last Name

Address

Telephone number

Email address

Position applied for

Date of application

18 years or older

yes

no

If you are under 18 years of age, can you furnish a work permit?

yes

no

Have you ever been employed with Stoddard County Ambulance before?

yes

no

If hired, can you present evidence of your identity and legal right to work in ths country?

yes

no

Date available to start work

What is your desired salary range or hourly rate of pay?

Type of employment desired

Full time

Part time

Seasonal

Temporary

Will you travel if the job requires

yes

no

Will you work overtime if required?

yes

no

Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicants disability. Please do not provide information about the existence of a disability, particular accomodation or whether accomodation is necessary. These issues may be addressed at a later stage of the extent premitted by law.

yes

no

Have you ever been fired or asked to resign from a job? If yes please explain below

yes

no

If yes to previous question, please explain here

I certify that all information I have provided in order to apply for and secure work with this employer is true,complete, and correct.yes no

I expressly authorize without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and education institutions and to verify the accuracy of all information proved by me in this application, resume or job interview. I hereby waive any an all rights and claims I may have regarding the employer, its agesnt, employees, or representives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other presons,corporations or organizations for furnishing such information about me.

Yes

No

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

yes

no

I understand this application remains current for only 30 days. At the conclusion of that time, if I not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

Yes

No

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervior or representative of employer is authorzied to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoin express language are valid unless they are in writing and signed by employer's president.

Yes

No

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

yes

no

I understand that any information provided by me that is found to be false, incomplete or misrepresnted in any respect will sufficient casue to (i) eliminate me from further consideration for employemt, or (ii) may result in my immediate discharge from the employers's service, whenever it is discoverd.yes no

I certify that I have read, fully understand and accept all terms of the foregoing applicant statement

yes

no

Employment History starting with most recent, include phone number and supervisor name

Education background starting with most recent school attended

References: provide at least three references please include phone number, years known and relationship

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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