Emergency Medical Service Application Format

Emergency Medical Service Application Format

- In game Character Information -

Section I - Personal Information


1. Name (Surname, Forename):

2. Date of Birth (DD/MM/YYYY):

3. Gender:
4(a)Weight:
5(b)Height:
6(c)Race:
7. Living Address:

8. Phone Number:


Section II – History


1. Biography (200 or more words):


2. Do you have any history with Medical Training?:

4. Why do you want to join the EMS? (50 words or more):

5. Are you, or have you been affected by an illness which could now affect your field work?:

5(a)Are you taking any medications?:

5(b)Do you think that you are physically and mentally fit to work for us?:

Section III – Background


1. Have you been convicted of a serious crime?:
1(a) If yes, what?:

2. Have you been arrested in the State of San Andreas?:
2(a) If yes, why?:


The EMS is an equal opportunity employer. By signing the bottom of the application you here-by give us permission to run a background check on you for previous charges.


Section IV – Employment


1. Where have you been previously employed?:
2. Licenses:
2. Are you currently employed?:
2(a)If yes, where?:
2(b)If yes, would you need to give notice if you were accepted to the Los Santos Fire Department?:

EMPLOYMENT REFERENCES:

1. Previous Employer:
2. Company:
3. Phone Number:

1. Previous Employer:
2. Company:
3. Phone Number:

Section V – Applicants Statement

I certify that the information given by me in this Application is true and correct. I understand and agree that if I provide any false or misleading information on this Application or in my pre-employment interviews, it may result in the revocation of an offer of employment or an immediate termination of my employment with EMS, regardless of when it is discovered. I hereby authorize my prior employers, all educational institutions that I have attended, and all individuals whom I have listed as references herein, to supply to the EMS Recruitment Staff, any and all information that they may have regarding my past employment, education, experience, and qualifications. I hereby authorize the EMS Recruitment Staff to investigate and obtain any and all oral and documentary information regarding my past employment, education, experience, and qualifications. I hereby release and agree to indemnify and hold harmless the EMS and all such prior employers, educational institutions, and individuals from any and all liability for providing any information regarding my past employment, experience, and qualifications.

I also hereby authorize the EMS to investigate and review my criminal records. I request, authorize, and consent to the release of any and all such information to EMS consistent with state and federal laws and hereby release and agree to indemnify and hold harmless every person or entity that communicates such information to the EMS from any and all liability for providing any information regarding my credit history or criminal records.

I understand and agree that, if I become employed by the EMS I will be employed on an "at-will" basis. This means that my employment may be terminated by either the EMS or me at any time, with or without cause, and with or without advance notice. I further understand and agree that the Department may demote or discipline me, or take other actions with respect to my employment, in its sole discretion, with or without cause, and with or without advance notice. I also understand that no person, other than the Hospital Manager or Co. Hospital Manager of the EMS, has the authority to modify the terms of my at-will employment, and that any such modification will not be binding unless it is in writing and signed by Hospital Manager Jeff Hopkins or Co. Hospital Manager N/A. No one has made any promises or commitments to me contrary to foregoing. Please sign below that you are aware and understand all parts of the Applicants Statement.

Your Sign::


- Out Of Character Information -

Section I – Personal Informations


1. Name:

2. Age:

3. Gender:

4. Timezone (GMT):

5. Rate your English Skills from 1-10:

6. Rate your role play skills from 1-10:

7. Do you have team speak? (required):

8. Do you have a microphone? (not required):




Section II – Server Statistics


1. In-Game Level:

2. Other In-Game Accounts:

3(a)Stats

Section III – In-Game Record

1. Have you ever been prisoned by an admin? (On any account):
1(a) If yes, why and when?:


2. Have you ever been banned by an admin? (On any account):
2(b) If yes, why and when?:

Your Sign: