Application

Application for Employment

Thank you for your interest in employment at NorthWest EMS. Please fill out the following application to be considered for employment. NorthWest is an equal opportunity employer. All applicants are considered for positions without regard to race, creed, color, religion, sex, sexual orientation, national origin, age, qualified disability or handicap, or veteran status.

Employee Information:

* Indicates required field

Name *

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Last

Email *

Phone Number *

Mailing Address *

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State

Zip Code

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Citizenship Status:

Are You A US Citizen? *

Yes No

If no, are you authorized to work in the US? *

Yes No

Previous NW EMS Employment:

Have you ever worked for NorthWest EMS? *

Yes No

If yes, what dates did you work for NorthWest EMS? *

Felony Information:

Have you ever been convicted of a felony? *

Yes No

If so, please explain *

Employment Information:

Position Applying For *

Employment Status Desired *

Education Information:

High School Name: *

High School Address *

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City

State

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Dates attended high school: *

Did you graduate high school? *

Yes No

College Name *

College Address *

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State

Zip Code

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Dates attended college: *

College Major/Program of Study *

Did you graduate college? *

Yes No

Other Education- Name of Institution *

Other Education- Address of Institution *

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City

State

Zip Code

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Other institution- dates attended: *

Major/Program of Study *

Did you graduate? *

Yes No

References:

Reference #1

Name *

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Last

Relationship *

Company *

Phone Number *

Address *

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State

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Reference #2

Name *

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Last

Relationship *

Company *

Phone Number *

Address *

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State

Zip Code

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Reference #3

Name *

First

Last

Relationship *

Company *

Phone Number *

Address *

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State

Zip Code

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Previous Employment:

Previous Employer #1:

Company Name: *

Phone Number *

Address *

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City

State

Zip Code

Country

Supervisor Name *

First

Last

Job Title *

Starting Salary *

Ending Salary *

Job Responsibilities *

Dates Employed *

Reason for Leaving *

May we contact your past employer? *

Yes No

Previous Employer #2:

Company Name *

Phone Number *

Address *

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Line 2

City

State

Zip Code

Country

Supervisor Name *

First

Last

Job Title *

Starting Salary *

Ending Salary *

Job Responsibilities *

Dates Employed *

Reason for Leaving *

May we contact your past employer? *

Yes No

Previous Employer #3:

Company Name *

Phone Number *

Address *

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Line 2

City

State

Zip Code

Country

Supervisor Name *

First

Last

Job Title *

Starting Salary *

Ending Salary *

Job Responsibilities *

Dates Employed *

Reason for Leaving *

May we contact you past employer? *

Yes No

Military Service:

Do you have any military service experience? *

Yes No

Rank at Discharge *

If yes, what dates where you in the military? *

Type of Discharge *

Branch *

If other than honorable discharge, please explain: *

Resume Upload *

Max file size: 500MB

EOE Disclaimer Agreement:

By checking the box below, I understand that in accordance with all Commonwealth of Pennsylvania and federal regulations, NorthWest EMS is an Equal Opportunity Employer. All applicants are considered for positions without regard to race, creed, color, religion, sex, sexual orientation, national origin, age, qualified disability or handicap, or veteran status. *

I Understand

Digital Signature

By writing my name in the boxes below, I certify that the statements made on this application and any supplements are true and correct to the best of my knowledge and belief. I authorize NorthWest EMS to verify such answers and investigate all references. I understand that any false statements on this application or supplements to it may be be considered sufficient cause for rejection of this application, or for dismissal, if detected subsequent to my employment. I further understand that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option, or the option of NorthWest EMS. *

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Narcan Administration

Heritage Valley Kennedy Hospital (formerly Ohio Valley Hospital) proudly serves residents in the Kennedy Township, McKee's Rocks and Stowe Township communities. NorthWest EMS is a subsidiary of Heritage Valley Health System.

Visit heritagevalley.org for more information, or call 877-771-4847