Apply — Millstadt Ambulance Service | Millstadt Ambulance Service

Position Applied For

Position *

Employment Type — Select all that apply *

Full-TimePart-TimePRNVolunteer

Days Available

Hours Available

Preferred Shift

Personal Information

Legal Name

First Name *

Last Name *

Middle Name

Date of Birth *

Social Security Number *

Phone Number *

Email Address *

Street Address

City, State, ZIP

Driver's License State

Driver's License Number

DL Expiration Date

Education

High School

School Name

Graduation Year

College / University

Institution

Degree

Field of Study

Graduation Year

EMS / Medical Training Program

Program Name

Certification Earned

Completion Date

Licensure & Certifications

Primary License

License Type

Issuing State

License Number

Expiration Date

Additional License (if applicable)

License Type

Issuing State

License Number

Expiration Date

NREMT (if applicable)

Level

Registry Number

Expiration Date

DEA Registration

PA / APRN / MD only

Registration Number

Expiration Date

Certifications

Name

Card #

Expires

BLS

ACLS

PALS

ITLS / PHTLS

NRP

FP-C / CCP-C

CPI / De-escalation

HazMat Awareness/Ops

FEMA / NIMS (100, 200, 700, 800)

Work History

List all relevant EMS/medical employment — most recent first.

Employer #1

Agency Name

Position Title

From

To

Full-Time / Part-Time / PRN

Supervisor Name & Contact

Reason for Leaving

Job Duties

Employer #2

Agency Name

Position Title

From

To

Full-Time / Part-Time / PRN

Supervisor Name & Contact

Reason for Leaving

Job Duties

Employer #3

Agency Name

Position Title

From

To

Full-Time / Part-Time / PRN

Supervisor Name & Contact

Reason for Leaving

Job Duties

Professional References

Minimum of 3 references required.

Reference #1

Name

Title

Relationship to You

Phone / Email

Reference #2

Name

Title

Relationship to You

Phone / Email

Reference #3

Name

Title

Relationship to You

Phone / Email

Additional Information

Why do you want to work for Millstadt Ambulance Service?

Describe a high-acuity patient you managed

Describe a time you worked effectively as part of a team

Attachments

Upload copies of your licenses, certifications, and supporting documents. Multiple files accepted. All documents will be attached to your application email.

Resume / CV

Cover Letter

Driver's License Copy

Professional License(s)

Certification Cards

Immunization Records

Additional Documents

Applicant Certification

I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that falsification or omission of information may result in disqualification from consideration or termination of employment.

I certify the above and agree that all information is true and complete. I consent to the background, drug, and driving record checks I selected above.

Back to Careers

Applications are sent to millstadtems@gmail.com and reviewed by Millstadt EMS leadership.

Apply to
Millstadt EMS

Position Applied For

Personal Information

Eligibility & Background

Education

Licensure & Certifications

Work History

EMS Experience & Skills

Driving History

I Am Willing To Work

Professional References

Additional Information

Attachments

Applicant Certification

Apply toMillstadt EMS

Position Applied For

Personal Information

Eligibility & Background

Education

Licensure & Certifications

Work History

EMS Experience & Skills

Driving History

I Am Willing To Work

Professional References

Additional Information

Attachments

Applicant Certification

Apply to
Millstadt EMS