Apply for Paratransit Coordinator

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Summary
Title:Paratransit Coordinator
ID:PC062424
Department:Administrative
Resume
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:
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NA Application
REFERRAL SOURCE
Walk-in   Employee   Advertisement   Company   Website   School   Other
Yes   No
Yes   No

If yes, please give dates:

Yes   No
TYPE OF EMPLOYMENT DESIRED
  
  
  
  
  
  
  
  
  
  
  
  
  
ACCOMMODATION QUESTIONS
Yes   No
Yes   No

(If reasonable accommodation is required, please attach a separate piece of paper explaining how you would perform the tasks and what accommodation is needed.)

AUTHORIZATION QUESTIONS
Yes   No
Yes   No
Yes   No
FORMAL EDUCATION
  
  
  
  

School 1

*
Yes   No
*
*
*
Degree   Diploma   GED   Certificate   Other

School 2

Yes   No
Degree   Diploma   GED   Certificate   Other

School 3

Yes   No
Degree   Diploma   GED   Certificate   Other
EMPLOYMENT HISTORY
Yes   No
Yes   No
Yes   No

(A "œNo" will not affect our review of your qualifications. If you answer "œNo" and we need to contact your present employer before we can offer you employment position, we will contact you first.)

NOTE:

Account for all periods of employment or unemployment in the past 10 years; paid or voluntary. Including periods of self-employment, military, and or sabbatical.

Employer 1

*
*
*
*
*

Employer 2

*
*
*
*
*

Employer 3

Employer 4

Employer 5
QUALIFICATIONS

List all certificates, licenses, and or memberships.

Driver's License

*
*

License 1

License 2

License 3

License 4
SKILLS

List number of years certified at each level.

  
  
LANGUAGES
Yes   No
  
  
  
  
  
  
REFERENCES

Please provide three references (not relatives).

Reference 1

*
*
*

Reference 2

Reference 3
PLACE OF RESIDENCE

List where you have lived for at past 10 years (Include month and year only).

Residence 1

Residence 2

Residence 3

Residence 4

Residence 5

Residence 6

Residence 7

Residence 8

Residence 9

Residence 10
ACCOMPLISHMENTS
APPLICANT STATEMENT OF AUTHORIZATIONS AND ACKNOWLEDGEMENTS TO TERMS OF EMPLOYMENT

My signature below indicates that I swear or affirm that the information contained on this application is true and correct to the best of my knowledge, and that I have read, understood, agreed, authorized, certified, and consented to the above statements. This authorization or photocopy shall serve as consent for National Ambulance to request any information concerning my application. I acknowledge that I have had the opportunity to ask questions about these terms and have them answered.


I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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