DRIVING RECORD RELEASE:

THE ABOVE NAMED PERSON HAS MADE AN APPLICATION OF DRIVER. AS IN ACCORDANCE WITH SECTION 391.23 FEDERAL DEPARTMENT OF TRANSPORTATION REGULATIONS, I ALLOW AND RELEASE TO CITIZENS AMBULANCE MY DRIVING RECORD OF THE PAST THREE YEARS.

BY CLICKING SUBMIT BELOW I ALLOW CITIZENS AMBULANCE TO RUN A DRIVING RECORD CHECK ON THE ABOVE NAMED PERSON.

CITIZENS AMBULANCE SERVICE IS AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER

IT IS THE POLICY OF CITIZENS AMBULANCE TO RECRUIT, HIRE AND PROMOTE FOR ALL JOB CLASSIFICATIONS ON THE BASIS OF MERIT, QUALIFICATION AND COMPETENCE. THIS APPLIES TO ALL CATEGORIES OF EMPLOYMENT, SUCH AS MANAGERIAL, PROFESSIONAL, TECHNICAL, AND SERVICE STAFF. NO ASPECT OF EMPLOYMENT SHALL BE INFLUENCED BY RACE, COLOR, NATIONAL ORIGIN, RELIGION, GENDER, AGE OR DISABILITY. ALL EMPLOYMENT DECISIONS WILL BE MADE SOLELY UPON THE BASIS OF THE INDIVIDUALS QUALIFICATIONS AS RELATED TO THE REQUIREMENT OF THE POSITION BEING FILLED.

ALL OF THE INFORMATION GIVEN BY ME IN THIS APPLICATION IS CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND AND AGREE THAT ANY MISREPRESENTATION, FALSIFICATION OR WILLFUL OMISSION OF FACTS SHALL BE SUFFICIENT CAUSE FOR REFUSAL OF EMPLOYMENT OR IMMEDIATE DISMISSAL. I HEREBY GRANT CITIZENS AMBULANCE SERVICE PERMISSION TO INVESTIGATE ANY INFORMATION IN THIS APPLICATION AND RELEASE ALL PARTIES (COMPANIES, SCHOOLS, OR PERSONS NAMED BY ME IN THE APPLICATION) FROM ALL LIABILITY FOR ANY DAMAGES FROM ISSUING THIS INFORMATION. I AGREE TO ABIDE BY PRESENT AND SUBSEQUENTLY ISSUED RULES OF CITIZENS AMBULANCE SERVICE IF EMPLOYED.

USE OF THIS APPLICATION DOES NOT INDICATE THAT THERE ARE ANY POSITIONS OPEN AND DOES NOT OBLIGATE CITIZENS AMBULANCE SERVICE. I FURTHER UNDERSTAND THAT SHOULD I RECEIVE AND OFFER, EMPLOYMENT IS CONTINGENT UPON A MANDATORY INVESTIGATION OF MY BACKGROUND, REFERENCES, AND DRIVING RECORD. I UNDERSTAND THAT I CANNOT BE EMPLOYED BY CITIZENS AMBULANCE SERVICE IF I HAVE ANY CHARGES PENDING OR HAVE A CONVICTION OF A FELONY OR A MISDEMEANOR OTHER THAN A MINOR TRAFFIC VIOLATION. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT IS TO BE "AT WILL" AND THAT EITHER I OR CITIZENS AMBULANCE SERVICE MAY TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE, UNLESS THE "AT WILL" ARRANGEMENT IS MODIFIED BY A WRITTEN AGREEMENT SIGNED BY BOTH ME AND THE COORDINATOR AND/OR DESIGNEE OF THE CITIZENS AMBULANCE BOARD.

***BY CLICKING SUBMIT BELOW I HAVE READ ALL OF THE ABOVE AND AGREE TO THE SAME***

PLEASE CLICK SUBMIT TO FINALIZE YOUR APPLICATION