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APPLICATION FOR EMPLOYMENT

Application for Employment

Elite Industrial Services, LLC considers applications for employment without regard to race, color, national origin, religion, sex, age, disability, or any other protected class. Elite Industrial Services, LLC is a DRUG FREE WORKPLACE.

“*” indicates required fields

"*" indicates required fields

Preferred Position

Select all that apply

Advanced EMT

Paramedic

EMT

Firefighter / EMT

Firefighter / Paramedic

Gate Coordinator

Office Admin (Corp. Only)

Finance/Acct (Corp. Only)

Site Preferred

Select all that apply

Airbus – Alabama

Elite Corporate – Mobile, AL

Elite EMS – Aledo, IL

Elite EMS – Andalusia, IL

Elite EMS – Geneseo, IL

SSAB – Alabama

SSAB – Iowa

Preferred Schedule

Part Time

Full Time

Days

Nights

Weekends

Do you hold a valid EMS license?*

Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Address*

Street Address City State ZIP Code

Phone*

Email*

Available Start Date*

MM slash DD slash YYYY

Are you eligible to work in the United States?*

YES

NO

High School Education*

High School Attended

Dates Attended

Degree Granted

College Education*

College Attended

Major Field

Dates Attended

Degree Granted

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High School Attended

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High School Graduation Year

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Education

GED

High School Diploma

College Education

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College Attended and Degree Type

Please list the names of any friends or relatives who work for Elite Industrial Services, LLC

Name

Relationship

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Please list the names of any friends or relatives who work for Elite Industrial Services, LLC

Certifications (Please include EMS License, BLS, ACLS, and PALS)*

Certification

Type

Cert. No.

Exp. Date

How did you find out about Elite Industrial Services?*

Employment History (Please include two)*

Employer

Position

City, St

Supervisor

Supervisor Phone#

Start Date

End Date

Professional Reference #1*

Name

Address

Phone

Relationship

Professional Reference #2*

Name

Address

Phone

Relationship

Have you ever had an adverse action taken against a professional license or certification including but not limited to sanction, consent order, suspension, revocation, or disbarment?*

Yes

No

If yes, explain:

Have you ever been convicted of a misdemeanor or felony (other than traffic violation)?*

Yes

No

If yes, explain:

Have you ever been excluded, debarred, suspended, or sanctioned from participating in any Federal or State healthcare related programs?*

Yes

No

If yes, explain:

Are you able to perform the job tasks or the essential functions of the position for which you have applied with or without accommodations?*

Yes

No

If no, explain:

Consent*

I AGREE

I attest that the above information is accurate and true to the best of my ability. Furthermore, I understand that the falsification of information will result in my ineligibility for any future employment with Elite Industrial Services, LLC and may result in termination upon discovery for hired applicants.

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