Are you looking to join our dynamic and dedicated team of healthcare professionals?  If so, please fill out our online application.  We appreciate your inquiry. Please use Internet Explorer to complete the application.

Please fax a copy of all certifications and current driver's license to 215.443.7550 along with the other application documents available on our careers page. Please make reference in the fax that you completed the online application process. For additional information please call 215.443.7003.

CONTACT INFORMATION
First Name:		Email Address
Middle Initial:		Home Phone:
Last Name:		Work Phone:
Address Line 1:		Cell Phone:
Address Line 2:		Social Security Number:
City:		Driver's License Number
State:	Choose A State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Driver's License State
Zip Code:		Driver's License Expiration Date

WORK INFORMATION
If you are under the age of 18 can you provide a work permit if offered a position? Yes No
Are you presently authorized to work in the United States? Yes No
If employed, proof of your right to work in the United Stated states must be provided prior to beginning work.
Position Desired:		Preferred Location:	Pennsylvania Other
Will you accept another position or location? Yes No
If yes, please specify:
Expected Salary:		Date Available:
Acceptable Working Days: Monday - Friday Weekend Other Acceptable Working Hours: Full Time Temporary Only Relief Only   Part Time     Please provide the total number of hours you are available per week: Hours
Have you previously applied for employment at Acute Care? Yes No
If yes, please provide the month and year in which you applied: January February March April May June July August September October November December 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990
Have you previously been employed at Acute Care? Yes No
If yes, please provide the month and year in which you were employed: January February March April May June July August September October November December 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990
EDUCATION INFORMATION
School Name/Location Years Completed From To Course of Study Graduated? Type of Degree High School Yes No Trade School Yes No College Yes No Graduate Yes No Other Yes No
Professional Licenses, Certifications, Permits:
Type of Certification Certification Number Expiration Date
Professional Memberships:
Please do not provide information which you believe reveals any of the following: age, race, creed, color, religion, sex, national origin, citizenship status, disability or sexual preference.
Please list any skills relevant to the position for which you are applying:
EMPLOYMENT HISTORY
Have you previously worked for an Ambulance/Ambulette company? Yes No
If yes, please indicate the name, address of company and dates of employment
Name: Phone Number: Address: Employed From: City: Employed To: State: Choose A State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     Zip:
Please account for all time since leaving school.  List your most recent employer and position first.
Most recent job and position: Employer Name: Employer Address: Employed From: Job Title: Employed Until: Supervisor: Phone Number: Salary: Briefly describe the work you performed:
Employment History Two: Employer Name: Employer Address: Employed From: Job Title: Employed Until: Supervisor: Phone Number: Salary: Briefly describe the work you performed:
Employment History Three: Employer Name: Employer Address: Employed From: Job Title: Employed Until: Supervisor: Phone Number: Salary: Briefly describe the work you performed:
Employment History Four: Employer Name: Employer Address: Employed From: Job Title: Employed Until: Supervisor: Phone Number: Salary: Briefly describe the work you performed:
Employment History Five: Employer Name: Employer Address: Employed From: Job Title: Employed Until: Supervisor: Phone Number: Salary: Briefly describe the work you performed:
MILITARY HISTORY
Branch Dates Served Reserve Status From: - Until: Yes No Type of duty and special training:
GENERAL INFORMATION
How were you referred to Acute Care?
Newspaper Advertisement (specify newspaper) Referred by Employee (Please specify) Employment Agency Radio Advertisement Professional Organization Live in Area Other (Please specify) School
Do you have relatives or friends currently employed at Acute Care? Yes No
Name Position
Have you ever been convicted of a crime? Yes No
If yes. give date(s), offense(s) and disposition(s).  A prior conviction record will not automatically disqualify you for consideration for employment.
We do not discriminate against any person because of race, color, religion, sex, age, national origin, disability, citizenship, marital status, veteran status, sexual orientation, or other status or condition protected by law.  We provide reasonable accommodation in accordance with acceptable law.  Our equal opportunity policy applies to all terms and conditions of employment. Equal Opportunity Employer M/F/D/V
Application Certification
I certify that all matters contained in this application are true, authorize their investigation and agree that any misleading or false statements would render this application void and would be sufficient cause for immediate dismissal in the event of employment. I understand that any offer of employment may be subject to satisfactory completion of a medical examination, which includes a toxicology screen and receipt by Acute Care of satisfactory references. I also understand that, if my position requires licensure, including a motor vehicle license, my continued employment is conditional upon maintenance of all applicable licensure. I further understand that Acute Care is committed to maintaining a "substance abuse free" environment for all its employees and that should the pre-employment medical evaluation reveal the presence of an illegal drug, misuse or abuse of a controlled substance or other substances which may alter or impair my behavior and/or ability to function, I will not be employed. If accepted for employment I agree to conform to the rules and regulations of Acute Care, except as may be modified by any subsequent written statement. I understand that no representative other than the President, Vice President, Director of Human Resources of Acute Care has any authority to enter into any agreement of employment with me for any specified period of time and to make any agreement contrary to the foregoing. I also understand that any oral or written statements to the contrary are hereby null and void. I also acknowledge that my employment may be terminated or any offer or acceptance of employment withdrawn, at any time, with or without cause and with or without prior notice at the option of the company or myself. (Authorize) By typing my name in this box I give permission to Acute Care to conduct any background checks and employment verifications during the application process. In connection with my application for employment (including contract for services) with ACUTE CARE MEDICAL TRANSPORTS, INC., I understand that consumer reports, which may contain public information, may be requested and obtained. These reports may include information related to my previous driving record including court actions, citations, and license suspensions and revocations. I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED TO FURNISH THE ABOVE-MENTIONED INFORMATION. I have the right to obtain information as to the name, address, and phone number of any agency providing such information and further may request of that agency, upon proper identification, the nature and substance of all information in its files on me at the time of my request, including all sources of information as well as the recipients of any reports on me which that agency has previously furnished within the two (2) year period preceding my request. This authorization shall remain on file and shall serve as ongoing authorization for the organization to procure Motor Vehicle Reports at any time during my employment, membership, or contract period. (Authorize2) By typing my name in this box I give permission to Acute Care to conduct any MVR checks and verifications during the application process.