CARE STAR EMS

3269 N Henry Blvd, Stockbridge, GA 30281

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470-854-8879

7 AM - 7PM
Monday - Saturday

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Employment Application

CARESTAR EMS considers applications for employment without regard to race, color, national origin,
ancestry, religion, sex age, disability, political belief, or any other protected class. CARESTAR EMS is a
DURG-FREE WORKPLACE!

This following information is required upon interviewing for employment with CARESTAR EMS

  • Driver License (copy)
  • Background Check Consent
  • Permanent Resident Card (copy)
  • Birth Certificate (copy)
  • Social Security Card (copy)
  • W4

  • Personal Information
  • Employement History
  • Ethical Background
  • EDUCATION AND TRAINING
  • REFERENCES
PERSONAL INFORMATION
POSITION INFORMATION
Seeking
Check the current certifications you are submitting with your application

1- EMPLOYMENT HISTORY: (List employers starting with the most recent)
May we contact

2- EMPLOYMENT HISTORY: (List employers starting with the most recent)
May we contact

3- EMPLOYMENT HISTORY: (List employers starting with the most recent)
May we contact

HAVE YOU EVER BEEN PLACED ON PROBATION, DISCIPLINED OR TERMINATED FOR ANY OF THE FOLLOWING: (Answer YES for any of the below questions will not necessarily disqualify you from employment)
Excessive absenteeism
Excessive tardiness
Insubordination
Violation of rules or regulations
Fighting or threats to flight
Harassment
Patient abuse
Careless or Reckless driving
Drug/alcohol related incidents
EDUCATION AND TRAINING
Did you graduate?
Certification obtained
Did you graduate?
Certification obtained
Did you graduate?
Certification obtained
Did you graduate?
Certification obtained
PROFESSIONAL REFERENCES:
PERSONAL REFERENCES: (Not relatives)
CRIMINAL HISTORY (By obtaining employment with CARESTAR EMS):
CRIMINAL History
ACKNOWLEDGMENT
Are you agree to this statement?
APPLICANT'S SIGNATURE



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