West Brookfield Rescue Squad
Application for EMTs seeking an interview with WBRS.

It is the policy of West Brookfield Rescue Squad Inc. to provide equal employment opportunity to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.
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Email *
Name: *
Phone Number: *
Home Address: *
City or Town / State *
Are you 18 years or older? *
Do you have a valid EMT certification? *
Is your EMT certification at the BLS level? *
Do you have a valid drivers license? *
How many years of EMT experience do you have? *
If experienced as an EMT, where have you been employed?
Please list any other employment history, including dates of employment and job titles *
How did you hear of WBRS? *
Have you applied to WBRS previously? *
If you answered yes to the above, when did you previously apply?
Do you have any friends or relatives who work here? If yes, please list: *
Do you hold any other certifications / licenses? *
If yes to previous question, please list:
Which are you seeking: *
What days are you available for work? *
Required
What shifts are you available to work? *
Required
Do you have reliable transportation? *
Do you have any other experience in the medical field other than EMS? *
Are you currently attending college? *
Education History: *
Have you ever served in the military? *
Hourly wage desired: *
If hired, are you able to submit proof that you are legally eligible for employment in the United States? *
If you are offered employment, when would you be available to begin work? *
Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation? *
What reasonable accommodation, if any, would you request?
Have you ever been convicted of a felony or misdemeanor? *
If you answered yes, when and where did the conviction occur? *The existence of a criminal record does not constitute an automatic bar to employment unless relevant to the type of employment
Please List Two References: *
Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
Certification: I certify that the information provided on this application is truthful and accurate. I understand providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.       I authorize West Brookfield Rescue Squad, Inc. to contact former employers and education organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.        If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be "at-will". In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of West Brookfield Rescue Squad, Inc., except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.      I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS. *
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