Murrysville Medic One
Employment Application

Lieutenant Hayden Geisweidt

(724) 327-3831  EXT. 105

hgeisweidt@station610.com

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Certifications

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Employment History

May we contact this employer?
May we contact this employer?
May we contact this employer?

Education

Did you Graduate
Did you Graduate
Did you Graduate
Did you Graduate

Criminal History

Have you ever been convited for a misdemeanor or felony?
Have you received a moving violation in the past 5 years?
Has your drivers license ever been suspended or revoked?
Have you ever been convicted of D.U.I?
Has your medical command privilages ever been suspended or revoked, or have you had restrictions placed on your certification?

Miscellaneous Questions

Would you decline to take a physical exam as a condition of employment?
Would you decline to take a drug test as a condition of employment?
Are you able to carry 150LBS, upstairs, downstairs and lift into an ambluance?
Do you have any physical or mental disabilities that would affect your performance for the position you are applying?
Do you have any past or present medical conditions or injuries that could be aggravated by or caused to reoccur by this job?
Are you currently under the care of any Health Professional for any illness or injury?
Do you have any allergies?
What days are you available to work?
What shifts are you available to work?
Are you interested in working overtime?

References

Employment Policies and Release Form

Murrysville Medic One

There are a number of Murrysville Medic One policies that an applicant needs to know about and agree to before being employed. There also are a number of activities the Murrysville Medic One may want to instigate as part of the review and investigation of the appropriate background information on an applicant. The purpose of this document is to present these policies and investigative activities to the applicant to ensure that they are understood and agreed to at the time the application is submitted.

 

Policies

 

Among the policies that have been adopted at Medic One are the following that we believe are important for an applicant to know in advance of employment. These are listed below. Your signature on this “Release Form” indicates that you have read, understand, and would agree to operate under these policies if employed at Murrysville Medic One.

 

  1. This service is an equal employment opportunity employer and does not discriminate because of age, sex, race, color, national origin, disability, or religious preference.

  2. Murrysville Medic One is a drug and alcohol free-workplace. To ensure worker safety and integrity of the workplace, Medic One prohibits the illegal manufacture, possession, distribution or use of controlled substances or alcohol in the workplace by its employees or those engage or seek to engage in business with Medic One

  3. Smoking is not permitted inside the building at Medic One. For the safety and health of its employees, Medic One is committed to a smoke-free building. This excludes the garage area.

 

Background Review Activities

 

Murrysville Medic One may conduct the following investigative activities as part of the background review of prospective employees. Your signature on this “Release Form” indicates you understand these activities and you authorize them to be performed with the conditions specified as listed below.

 

  1. Persons convicted of specific crimes may not hold certain positions at this company. If you are applying for such a position and have been convicted of a felony, please note this below. If more space is needed, please provide the additional information on a separate sheet of paper. In addition, you authorize Medic One to undertake a criminal records check with state police officials

  2. You authorize Medic One to obtain a Motor Vehicle Record report. Our insurance company may also obtain a report through its sources. If the position you are applying for involves driving a motor vehicle, it is imperative that a good driving record exists.

  3. You also authorize and request any and all of your former employers to furnish any and all information regarding your job performance. You agree to hold your former employers and their agents harmless from all liability that could relate in any way to the disclosure of private information or an assessment or opinion of your suitability for employment.

 

In closing, we ask that you read (and complete where needed) the remaining three (3) statements and that your signature on this Release form indicates you understand each.

 

  1. I have read and understand the job description for the position of                                                          as approved on the date of 

    2. I understand that misrepresentation or omission of facts herein is cause for termination, if employed.

 

    3. I have read and understand the attached application and have answered all portions of the application truthfully and correctly          with no omissions.

 

 

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EMERGENCY - 911                              DISPATCH - (724) 327-1222                              NON-EMERGENCY - (724)  327-3831