Employment Application

"*" indicates required fields

Name

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Desired Hourly Rate

Referred by*

Contact Me By

What type of hours can you work?*

Preferred Station & Position*

TDSHS License number*

Have you ever worked at WindsorEMS before?*

Yes

When did you work for WindsorEMS?

Have you ever been convicted of a crime?*

Yes

Please provide dates and details.

Have you had any traffic convictions in the last 5 years?*

Yes

Please provide dates and details

Date Available*

Have you ever been forced to resign for misconduct or unsatisfactory performance?*

Yes

Are you a military veteran?*

Yes

Are you eligible to work in the United States?*

Yes

Date of Birth?*

Current / Last Employer*

May we contact your previous employer?*

Yes

Are you currently employed?*

Yes

Supervisor's name*

First Last

Supervisor Contact Number*

Supervisor Email*

Start Date*

End Date*

Reason for Leaving*

What is your education level?*

High school

2-Year College

4-Year College

Location*

Did you graduate?*

Cut and Paste Resume or (list Employment History with Names & Numbers) here:

Resume File

Accepted file types: jpg, gif, png, pdf, docx, xlsx, zip, Max. file size: 300 MB.

List Three References and add any additional comments here:*

PLEASE READ CAREFULLY*

I agree

EMPLOYMENT APPLICATION AGREEMENT – WINDSOR EMS
1. Employment Relationship Status
In exchange for the consideration of my job application by Windsor EMS, I agree that neither the acceptance of this application nor the subsequent entry into any type of employment relationship — whether in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, or other Company practices — shall serve to create an actual or implied contract of employment or confer any right to remain an employee of Windsor EMS.
2. At-Will Employment
I understand that employment with Windsor EMS is at-will, meaning that either I or Windsor EMS may terminate the employment relationship at any time, with or without notice or cause. This at-will relationship may only be modified by a written agreement signed by an authorized representative of Windsor EMS.
If employed, I understand that Windsor EMS may unilaterally change or revise its benefits, policies, and procedures at any time, including reductions in benefits.
3. Background Investigation & Verification
I authorize Windsor EMS to investigate all statements contained in this application. I understand that any misrepresentation or omission of facts may result in dismissal at any time without prior notice.
I hereby give Windsor EMS permission to contact schools, previous employers (unless otherwise indicated), references, and others, and I release Windsor EMS from any liability resulting from such contacts.
4. Drug & Alcohol Policy
I understand that
- Windsor EMS maintains a drug and alcohol policy that includes pre-employment and post-employment testing;
- My consent to and compliance with such policy is a condition of employment; and
- Continued employment is contingent upon successfully passing such testing.
5. Physical Examinations
I further understand that continued employment may be contingent upon successfully passing job-related physical examinations.
6. Consumer Report & Privacy
I understand that, as part of the application process, Windsor EMS may request an investigative consumer report from a consumer reporting agency, which may include information regarding my credit history, character, general reputation, personal characteristics, and mode of living. Upon written request, Windsor EMS will provide additional information concerning the nature and scope of such report, as required by the Fair Credit Reporting Act.
7. Probationary Period
I understand that my employment with Windsor EMS will be considered probationary for a period of ninety (90) days. During this period, and at any time thereafter, my employment remains at-will and may be terminated by either party for any lawful reason.
8. Workers' Compensation & Work-Related Injury Benefits
I understand that Windsor EMS maintains workers' compensation coverage and/or a federally governed ERISA plan, as applicable, to provide benefits in the event of a work-related injury or illness. I also understand that if a physician places me on light duty, Windsor EMS is not obligated to provide a light-duty assignment.
9. Anti-Harassment Policy
I understand that Windsor EMS prohibits sexual harassment and all forms of unlawful harassment. I acknowledge my obligation to report any such conduct and understand that violations may result in disciplinary action up to and including immediate termination.
10. Equal Employment Opportunity
Windsor EMS is an equal employment opportunity employer. We make employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, or disability. Employment opportunities are based solely on qualifications.
11. Retention of Application
Your application for employment will be maintained in our Human Resources Department for six (6) months.

Signature

Date*

Print Name*

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