Please complete the application below

Jackson County EMS is an equal opportunity employer. No question on this application is asked for the purpose of limiting or excluding any applicant's consideration for employment because of race, color, religion, age, sex, national origin, disability, or any other characteristic protected by law.

Name *
Address *
Daytime Phone *
Daytime Phone
Evening Phone
Evening Phone
Have you ever applied with us before? *
Are you legally allowed to work in the United States? *
Are you 19 Years of Age or Older? *
Have you ever been convicted of a felony or criminal misdemeanor? *
Note: A past conviction does not automatically exclude an applicant from being considered for employment.
Have you ever worked for Jackson County EMS before? *
Position that you are applying for. *
Select all that apply
I am applying for. *
Any Accreditations? *
Do you have a high school diploma or equivalent? *
Are you able to work: *
Are you available to work overtime? *
Previous Employment History
Previous Employer #1
If this is your current employer, write "Current"
May we contact? *
Previous Employer #2
If this is your current employer, write "Current"
May we contact?
References may not be related to you: Include their Name, Title, Address, Phone Number, and how long you have known them.
Have you ever been discharged, asked to resign, or resigned to avoid a discharge from any position? *
Please write any additional comments you would like to be considered below
Type your name/signature below. By Clicking submit you attest that you agree and understand the statements and conditions above.