PERSONAL INFORMATION

Email

JOB INTEREST

Salary Desired

WORK HOURS/SHIFT PREFERRED

EDUCATIONAL RECORD

Highest Grade Completed

Highest College or Graduate School Completed

Schooling Information

NAME, CITY, STATE OF SCHOOLS ATTENDED, MAJOR FIELD, DEGREE, & YEAR GRADUATED

PROFESSIONAL LICENSES/CERTIFICATIONS

Licenses and/or Certifications

Type - State Issued - Date Issued - Expires On - Number

Please list job related organizations, clubs, professional societies, or other associations to which you belong

WORK EXPERIENCE

What other names have you worked under?

List your last or present employer first and account for any lapse of time between employment. List at least Three employers or employment history of five years, which ever is greater.

Employer 1

Employer - Employed From - Street Address - Position Title - Salary (starting and final) - Supervisors Name - Person we may contact for reference - Duties - Reasons for leaving

Employer 2

Employer - Employed From - Street Address - Position Title - Salary (starting and final) - Supervisors Name - Person we may contact for reference - Duties - Reasons for leaving

Employer 3

Employer - Employed From - Street Address - Position Title - Salary (starting and final) - Supervisors Name - Person we may contact for reference - Duties - Reasons for leaving

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION FORM

I understand that employment at OTEMS is at will and that either OTEMS or I can terminate the employment relationship at any time, for any reason, with or without notice. I further understand that neither this application nor any other OTEMS communication I may receive constitutes an employment contract. I authorize OTEMS to contact any or all of my references and former employers listed herein and to inquire about my employment. I release OTEMS and any employer or reference which is contacted from any liability arising out of such inquiry or the response to such inquiry. I certify that the statements contained herein are true to the best of my knowledge and belief. I understand that any false or misleading statement, receipt of unsatisfactory references, an unsatisfactory result of drug screening test, an unsatisfactory result of a criminal background check or an unsatisfactory result of the prescribed physical examination which reveals that I cannot perform the essential functions of my job with or without accommodation may result in ineligibility for hire and/or discharge.

OTEMS careers are more than jobs; they're opportunities to pursue your passions and impact the lives of the people in our community.