Employment ApplicationName First Last Email PhoneAddress Street Address City State / Province / Region ZIP / Postal Code Desired Hourly RatePreferred Station*Clear LakeSpring/WoodlandsSugar LandMedical CenterForest Bend 911What type of hours can you work?*Full TimePart Time (Less than 20Hrs/Wk)Part Time (More than 20Hrs/Wk)Which position are you applying for?*ParamedicEMT-BWheelchair Transportation SpecialistCertified ParamedicCommunicationsDispatcherAdministrationBillingTDSHS License number*Referred by*Contact Me ByPhoneEmailHave you ever worked at WindsorEMS before?*YesNoWhen did you work for WindsorEMS? Date Format: MM slash DD slash YYYY Have you ever been convicted of a crime?*YesNoPlease provide dates and details.Have you had any Traffic convictions?*YesNoPlease provide dates and detailsDate Available* Date Format: MM slash DD slash YYYY Have you ever been forced to resign for misconduct or unsatisfactory performance?*YesNoAre you eligible to work in the United States?*YesNoAre you at least 21 years of age?*YesNoCurrent / Last Employer*Are you currently employed?*YesNoSupervisor's name* First Last Supervisor Contact Number*Supervisor Email* Start Date* Date Format: MM slash DD slash YYYY End Date* Date Format: MM slash DD slash YYYY Reason for Leaving*Summarize education skills here:*Cut and Paste Resume or (list Employment History with Names & Numbers) here:*List Three References and add any additional comments here:*CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.