Application for Employment

Please answer the following questions to the best of your ability.  This information will be used to screen potential applicants.  All Contact Information must be complete.

Contact Information:

Name:

Address:

City, State  ZIP:

Phone:

Alt. Phone:

Email Address:

Best Time to be Reached:

Position Desired:

Position:

Available Weekends/Holidays:

YESNO

Minimum Pay:

Date Available:

Work Location Preference (Rochester or Corning):

Education/Training:

Education:

High SchoolSome CollegeAssociates DegreeBachelors DegreeGraduate StudiesOther

EMS Certification Level:

CFREMT-DEMT-IEMT-CCEMT-P

Other Courses:

Drivers License #:

Drivers License Class:

Drivers License Restrictions:

Drivers License Endorsements:

Rural/Metro Corporation and Federal and State laws prohibit discrimination on the basis of race, color, religion, national origin, sex, age or disability.  Rural/Metro Medical Services is an equal opportunity employer.