United Ambulance Service
Wheelchair Services Division
Please fill in as much of what applies to you.
ACLS (Medics Only)
Health Care Provider CPR
PHTLS or BTLS
Medical Priority EMD
Please list your last three (3) employers starting with the most recent position. Please include military experience if applicable.
This Application does not create a contract for employment and all positions at United Ambulance Service are employees at will.
Applicants Certification and Agreement (Please read carefully):
By checking the box below, I certify that the answers given by me to the foregoing questions and statements are correct without consequential omissions of any kind whatsoever. I do agree not to hold United Ambulance Service liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in the questionnaire. I authorize nursing homes, hospitals, companies, or person’s names as former employers to give any information regarding my employment and I hereby release said employers from all liability for any damages for issuing this information.