[PDF] Dossier du mois : - Aaems
L'AFGES les étudiant-e-s d'Alsace est une fédération territoriale Elle fé- dère et donc rassemble des associa- tions sur le territoire alsacien et ce
Edition speciale FINALE
[PDF] Dossier du mois : retour sur la PIN'S 2020 - Aaems
6 oct 2020 · pour devenir un as de la représentation étudiante Dossier du mois : retour sur la PIN'S 2020 Découvrez l'AAEMS et les MEDIS à la page 3
GCS Edition Octobre version finale
Release characteristics of AAEMs and physicochemical structural
characteristics of alkali and alkaline earth metals (AAEMs) and its correlation with changes of physical and chemical properties of char
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[PDF] Programme de le PIN'S (période d'insertion des nouveaux étudiants
5 sept 2019 · l'AAEMS SOIREE X X Soirée de rentrée (Sous réserve de modifications) Qu'est-ce que la PINS? Cette période de rentrée est l'occasion
pre rentree programme
[PDF] 7th AAEMS Executive Committee Meeting Venue
Venue A meeting room CSIR- Indian Institute of Chemical Biology Kolkata India Date December 11 (Thu) 2014 Time 13:30 – 14:30 Participants AAEMS
thAAEMScommittee
[PDF] 1 The Minute of the 5 AAEMS Executive Committee Meeting Venue
23 jan 2013 · Venue Jia Nian Hall Zhejiang NARADA Grand Hotel Hangzhou China Date October 23 2012 Time 4 00 – 6 00 pm Participants AAEMS
minute th board
[PDF] ALBANY AREA EMS EMPLOYMENT APPLICATION
I understand that Albany Area EMS herein identified as “AAEMS” requires certain information about me to evaluate my qualifications for employment and to
AAEMS Crew Application
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![[PDF] ALBANY AREA EMS EMPLOYMENT APPLICATION](https://pdfprof.com/PDF_DocsV2/Docs/PDF_3/50_3AAEMS_Crew_Application.pdf.jpg "[PDF] ALBANY AREA EMS EMPLOYMENT APPLICATION")
ALBANY AREA EMS EMPLOYMENT APPLICATION
1https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
3.25.22
APPLICANT NAME: ____________________________________________DATE OF APPLICATION: ______/______/______
POSITION APPLYING FOR:
_____AEMT _____EMT _____EMR _____Driver _____OtherAPPLICATION INSTRUCTIONS
Please complete the application in its entirety. Please print clearly or type with blue or black ink. When
submitting the application, if you want, you can attach any of the documents listed below as we will need these
upon hiring: Please check the items you have provided with this application. DO NOT FORGET TO SIGN THE
APPLICATION.
When completed please return to:
Albany Area EMS
208 N Water St.
Albany, WI 53502
Questions? Call (608) 862-3249
ATTACHED ITEMS
Copy of a current license or WI ID REQUIRED
Copy of your social security card REQUIRED
Copy of a current WI EMS license REQUIRED FOR EMS FIELD POSITION Copy of a current CPR card REQUIRED FOR EMS FIELD POSITION Copy of a current emergency vehicle operators certification (EVOC)Copy of any/all FEMA certifications
TRACKING: OFFICE USE ONLY
DATE RECEIVED ______/______/______ DATE EMS LICENSE CONFIRMED:______/______/______ INTERVIEW SCHEDULED DATE: ______/______/______ Time: ________________ HIRED: _____Yes _____No If no, why: ____________________________________________________________BACKGROUND CHECK DATE: ______/______/______
REFERENCE CHECK DATE: ______/______/______, ______/______/______, ______/______/______BOARD APPROVED DATE: ______/______/______
ALBANY AREA EMS EMPLOYMENT APPLICATION
2https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
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GENERAL INFORMATION
__________________ ________________________ (First) (Middle) (Last) Birthdate: ______/______/______ Social Security Number ___________________________________ Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Are you eligible for employment in the US: _____Yes _____No Explain: _______________________________ Have you ever been convicted of a crime: _____Yes _____No Explain: _________________________________ Please indicate the date you are available to start work: ______/______/______ Please indicate desired work schedule: ______________________________________________ Please indicate days or times you cannot work: ________________________________________GENERAL EDUCATION
Do you have a: _____High school Diploma _____GED Year Graduated: _________ Name of High School: ___________________________________________________EMS EDUCATION
Course: _____AEMT _____EMT _____EMR _____Driver _____OtherDate Course Completed: ______/______/______
Course taken at: ________________________________________________________ Course: _____AEMT _____EMT _____EMR _____Driver _____OtherDate Course Completed: ______/______/______
Course taken at: _________________________________________________________ Other EMS related courses: _____________________________________________________________ALBANY AREA EMS EMPLOYMENT APPLICATION
3https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
3.25.22
EMS LICENSE AND CERTIFICATIONS
Current WI License Level: _____AEMT _____EMT _____EMR _____Driver _____Other WI State License # _____________________ Expiration Date: ______/______/______ Are you currently Nationally Registered? _____Yes _____No NREMT License # _____________________ Expiration Date: ______/______/______ Are you a licensed EMS Instructor? _____Yes _____No Instructor License # _____________________ Expiration Date: ______/______/______ Have you had any disciplinary actions against your EMS license? _____Yes _____No If yes, explain: ________________________________________ Medical control authorities you have worked in: ________________________________________ Current CPR Certification Expiration Date: ______/______/______Are you a CPR instructor: _____Yes _____ No
CPR Instructor License # _____________________ Expiration Date: ______/______/______ Affiliated with: ________________________________________DRIVING RECORD
WI License # _____________________ Expiration Date: ______/______/______Years Driving: _____________________
Do you have experience driving emergency vehicles? _____Yes _____No How many years: _________Driving Offenses:
Date: ______/______/______ Offense _______________________________________ Points: Date: ______/______/______ Offense _______________________________________ Points: Has your license ever been suspended or revoked? _____Yes _____No If yes, explain: _______________________________________________________________________________ALBANY AREA EMS EMPLOYMENT APPLICATION
4https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
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REFERENCES: Provide at least three
Name: ____________________________________ Relationship: _______________Years known: ___________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ Name: ____________________________________ Relationship: _______________Years known: ___________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ Name: ____________________________________ Relationship: _______________Years known: ___________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ALBANY AREA EMS EMPLOYMENT APPLICATION
5https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
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PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING I understand that Albany Area EMS, herein identifAAEMSevaluate my qualifications for employment and to conduct its business if I become an employee. Therefore, I
authorize AAEMS to investigate my past criminal record, education credentials, and other employment related
activities.I certify that all the above information is true and complete in all respects and that I am submitting this
information and any other information during the application process so that AAEMS can rely on this information
in making employment decisions. I understand that any false answers or statements made by me on thisapplication, regardless of when discovered, by AAEMS, will be grounds for immediate disqualification or
discharge. I understand, also, that I am required to abide by all rules and regulation of AAEMS, and all local,
State of Wisconsin, and Federal rules governing ambulance operations, or any other such applicable rules or laws.
I understand that any offer of employment may be contingent upon, a criminal background and motor vehicle
operator record check, and that AAEMS will do periodic criminal background and motor vehicle operator record
checks. I understand that I cannot operate company vehicles until I am at least 21 years of age, and that operating
AAEMS vehicle is contingent upon having a good driving record and completing all required training.I understand I will make myself available for one crew training per month and all mandatory training activities as
required for licensure, re-licensure, or as required by medical direction.I understand that my certifications, such as CPR, will need to be kept current along with my state license. If they
expire, I will not be able to provide any type of patient care.I understand that there are minimum requirements of on call time and will fulfill those requirements each month
or reimburse AAEMS for costs of licensure as agreed upon with the Educational Agreement.I agree to abide by the Bylaws and Policies and Procedures Manual as well as protocols set by medical direction.
Failure to do so can result in disciplinary action which may include immediate dismissal from AAEMS membership. I understand that this application does not guarantee membership to AAEMS. I acknowledge that I have read, understand, and agree to abide by the terms above. Signature of Applicant: ______________________________ Date: ______/______/______ALBANY AREA EMS EMPLOYMENT APPLICATION
1https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
3.25.22
APPLICANT NAME: ____________________________________________DATE OF APPLICATION: ______/______/______
POSITION APPLYING FOR:
_____AEMT _____EMT _____EMR _____Driver _____OtherAPPLICATION INSTRUCTIONS
Please complete the application in its entirety. Please print clearly or type with blue or black ink. When
submitting the application, if you want, you can attach any of the documents listed below as we will need these
upon hiring: Please check the items you have provided with this application. DO NOT FORGET TO SIGN THE
APPLICATION.
When completed please return to:
Albany Area EMS
208 N Water St.
Albany, WI 53502
Questions? Call (608) 862-3249
ATTACHED ITEMS
Copy of a current license or WI ID REQUIRED
Copy of your social security card REQUIRED
Copy of a current WI EMS license REQUIRED FOR EMS FIELD POSITION Copy of a current CPR card REQUIRED FOR EMS FIELD POSITION Copy of a current emergency vehicle operators certification (EVOC)Copy of any/all FEMA certifications
TRACKING: OFFICE USE ONLY
DATE RECEIVED ______/______/______ DATE EMS LICENSE CONFIRMED:______/______/______ INTERVIEW SCHEDULED DATE: ______/______/______ Time: ________________ HIRED: _____Yes _____No If no, why: ____________________________________________________________BACKGROUND CHECK DATE: ______/______/______
REFERENCE CHECK DATE: ______/______/______, ______/______/______, ______/______/______BOARD APPROVED DATE: ______/______/______
ALBANY AREA EMS EMPLOYMENT APPLICATION
2https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
3.25.22
GENERAL INFORMATION
__________________ ________________________ (First) (Middle) (Last) Birthdate: ______/______/______ Social Security Number ___________________________________ Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Are you eligible for employment in the US: _____Yes _____No Explain: _______________________________ Have you ever been convicted of a crime: _____Yes _____No Explain: _________________________________ Please indicate the date you are available to start work: ______/______/______ Please indicate desired work schedule: ______________________________________________ Please indicate days or times you cannot work: ________________________________________GENERAL EDUCATION
Do you have a: _____High school Diploma _____GED Year Graduated: _________ Name of High School: ___________________________________________________EMS EDUCATION
Course: _____AEMT _____EMT _____EMR _____Driver _____OtherDate Course Completed: ______/______/______
Course taken at: ________________________________________________________ Course: _____AEMT _____EMT _____EMR _____Driver _____OtherDate Course Completed: ______/______/______
Course taken at: _________________________________________________________ Other EMS related courses: _____________________________________________________________ALBANY AREA EMS EMPLOYMENT APPLICATION
3https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
3.25.22
EMS LICENSE AND CERTIFICATIONS
Current WI License Level: _____AEMT _____EMT _____EMR _____Driver _____Other WI State License # _____________________ Expiration Date: ______/______/______ Are you currently Nationally Registered? _____Yes _____No NREMT License # _____________________ Expiration Date: ______/______/______ Are you a licensed EMS Instructor? _____Yes _____No Instructor License # _____________________ Expiration Date: ______/______/______ Have you had any disciplinary actions against your EMS license? _____Yes _____No If yes, explain: ________________________________________ Medical control authorities you have worked in: ________________________________________ Current CPR Certification Expiration Date: ______/______/______Are you a CPR instructor: _____Yes _____ No
CPR Instructor License # _____________________ Expiration Date: ______/______/______ Affiliated with: ________________________________________DRIVING RECORD
WI License # _____________________ Expiration Date: ______/______/______Years Driving: _____________________
Do you have experience driving emergency vehicles? _____Yes _____No How many years: _________Driving Offenses:
Date: ______/______/______ Offense _______________________________________ Points: Date: ______/______/______ Offense _______________________________________ Points: Has your license ever been suspended or revoked? _____Yes _____No If yes, explain: _______________________________________________________________________________ALBANY AREA EMS EMPLOYMENT APPLICATION
4https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
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REFERENCES: Provide at least three
Name: ____________________________________ Relationship: _______________Years known: ___________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ Name: ____________________________________ Relationship: _______________Years known: ___________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ Name: ____________________________________ Relationship: _______________Years known: ___________ Current phone number: (____) _____-_______ Alternate phone number: (____) _____-_______Email: ________________________________________
Current Address: _________________________________________________ Apt #: _____ City: ______________________ State: _______________ Zip Code: _____________ALBANY AREA EMS EMPLOYMENT APPLICATION
5https://blackhawk0-my.sharepoint.com/personal/kbriggs_blackhawk_edu/Documents/EMS/Crew/Job Descriptions - Interviewing/Crew Application.docx
3.25.22
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING I understand that Albany Area EMS, herein identifAAEMSevaluate my qualifications for employment and to conduct its business if I become an employee. Therefore, I
authorize AAEMS to investigate my past criminal record, education credentials, and other employment related
activities.I certify that all the above information is true and complete in all respects and that I am submitting this
information and any other information during the application process so that AAEMS can rely on this information
in making employment decisions. I understand that any false answers or statements made by me on thisapplication, regardless of when discovered, by AAEMS, will be grounds for immediate disqualification or
discharge. I understand, also, that I am required to abide by all rules and regulation of AAEMS, and all local,
State of Wisconsin, and Federal rules governing ambulance operations, or any other such applicable rules or laws.
I understand that any offer of employment may be contingent upon, a criminal background and motor vehicle
operator record check, and that AAEMS will do periodic criminal background and motor vehicle operator record
checks. I understand that I cannot operate company vehicles until I am at least 21 years of age, and that operating
AAEMS vehicle is contingent upon having a good driving record and completing all required training.I understand I will make myself available for one crew training per month and all mandatory training activities as
required for licensure, re-licensure, or as required by medical direction.I understand that my certifications, such as CPR, will need to be kept current along with my state license. If they
expire, I will not be able to provide any type of patient care.I understand that there are minimum requirements of on call time and will fulfill those requirements each month
or reimburse AAEMS for costs of licensure as agreed upon with the Educational Agreement.I agree to abide by the Bylaws and Policies and Procedures Manual as well as protocols set by medical direction.
Failure to do so can result in disciplinary action which may include immediate dismissal from AAEMS membership. I understand that this application does not guarantee membership to AAEMS. I acknowledge that I have read, understand, and agree to abide by the terms above. Signature of Applicant: ______________________________ Date: ______/______/______- aaems boutique
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