Employment Opportunites – Loyalsock VFC

Positions Available

Currently accepting applications for Part-Time Emergency Medical Technicians (EMTs) and Firefighter-EMTs.

Please fill out one of the applications for the position of interest below:

**** Important: Please do not send applications via Facebook or other social media avenues. Any applications submitted by mail or physically dropped off at the station to the attention of:

Chief Michael Minnier

715 Northway Road

Williamsport, PA 17701

All questions in regards to each of the part-time positions can be directed to Chief Minnier at 570-323-3603 ****

Susquehanna Mutual Aid Regional Team

Applicant Information

Full Name (Last, First, Middle Initial):

Date of Application

Please select the date in which you are applying for employment.

Address

City:

State

Zip Code:

Phone:

Email Address:

Date Available:

Social Security Number:

Positions Applied for:

Desired Salary: $

Driver's License Number:

Driver's License State:

Driver's License Expiration Date:

Copy of Driver's Licenses

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

Please submit a copy of your driver's license.

Are you authorized to work in the U.S.?

Do you or will you require a Permit/VISA to continue working in the United States?

Have you ever been convicted of a felony?

If you selected Yes in the above question, please explain here:

Education

Please fill out and complete all education information applicable. If you do not have any information to complete in required fields, please put N/A.

High School (Name of School):

School Address:

Dates of Attendance: (Lowest to Highest, example: 2006-2009)

Did you Graduate?

Diploma

Other (If you attended multiple schools, please list and explain here):

College / University Name:

College / University Address:

Years of Attendance (Lowest to Highest, example: 2009-2013)

Did you Graduate?

Degree (Please list Degree, Minor, Certificate, example: Major in Fire Science; Minor in Emergency Medicine):

If you attended multiple schools, please list the institutions name, dates of attendance, educational method and subject area, and include any details relevant to the position for which you are applying. (Example: Bucks Community College, Public Safety Courses 2000-current, refreshers continue education).

References

Please complete all information for three references of your selection.

Reference #1 Full Name

Company Name:

Relationship:

Professional (Supervisor / Manager, Coworker / Colleague, Subordinate / Direct Report). Educational (Instructor, Professor, Advisor) Personal (Family Friend, Person that knows you best).

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference # 2 Full Name

Relationship:

Professional (Supervisor / Manager, Coworker / Colleague, Subordinate / Direct Report). Educational (Instructor, Professor, Advisor) Personal (Family Friend, Person that knows you best).

Company Name:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference #3 Full Name

Relationship:

Professional (Supervisor / Manager, Coworker / Colleague, Subordinate / Direct Report). Educational (Instructor, Professor, Advisor) Personal (Family Friend, Person that knows you best).

Company Name:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employment History

Please list your three most recent employers.

of please false

Employer 1:

Employer 1 Address:

Street Number, Street Name, City, State, Zip Code

Employer 1 Phone Number:

Employer 1 Supervisor (Please include phone number for supervisor):

Employer 1 Job Title:

Employer 1 Salary (Please list starting and ending salaries if applicable):

Employer 1 Roles / Responsibilities:

Employer 1 Term of Employment (Please include estimated start date):

Employer 1 Reason for leaving:

Employer 2:

Employer 2 Address:

Street Number, Street Name, City, State, Zip Code

Employer 2 Phone Number

Employer 2 Supervisor (Please include phone number for supervisor):

Employer 2 Job Title:

Employer 2 Salary (Please list starting and ending salaries if applicable):

Employer 2 Roles / Responsibilities:

Employer 2 Term of Employment (Please include estimated start date):

Employer 2 Reason for leaving:

Employer 3:

Employer 3 Address:

Street Number, Street Name, City, State, Zip Code

Employer 3 Phone Number

Employer 3 Supervisor (Please include phone number for supervisor):

Employer 3 Job Title:

Employer 3 Salary (Please list starting and ending salaries if applicable):

Employer 3 Roles / Responsibilities:

Employer 3 Term of Employment (Please include estimated start date):

Employer 3 Reason for leaving:

Fire / EMS Service

Please complete if you have any prior Fire or EMS service experience. Example: Volunteer with another fire company or employed previously with another EMS service if different from the employer section listed above.

Fire / Emergency Medical Services

Company Name:

Years of Service (Lowest to Highest; example: 2000-2002; 2000-Present):

Chief's Name:

Chief's Phone Number:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I authorize the Loyalsock Volunteer Fire Company No. 1 to perform any additional criminal background check on my behalf and understand it is my responsibility to complete such forms to include the same information regarding my past criminal history as a requirement for employment. In addition, I authorize Loyalsock Volunteer Fire Company No.1 to contact my list of references provided as part of my character makeup prior to and following the employment interview.

Digital Signature (Please enter your name)

By signing this document, you acknowledge and certified that all information filled out is correct. Any misrepresentation may result in disqualifying chances for employment with our organization.

Paid Staff-EMS

Applicant Information

Full Name (Last, First, Middle Initial):

Date of Application

Please select the date in which you are applying for employment.

Address

City:

State

Zip Code:

Phone:

Email Address:

Date Available:

Social Security Number:

Positions Applied for:

Desired Salary: $

Driver's License Number:

Driver's License State:

Driver's License Expiration Date:

Copy of Driver's Licenses

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

Please submit a copy of your driver's license.

Are you authorized to work in the U.S.?

Do you or will you require a Permit/VISA to continue working in the United States?

Have you ever been convicted of a felony?

If you selected Yes in the above question, please explain here:

Education

Please fill out and complete all education information applicable. If you do not have any information to complete in required fields, please put N/A.

High School (Name of School):

School Address:

Dates of Attendance: (Lowest to Highest, example: 2006-2009)

Did you Graduate?

Diploma

Other (If you attended multiple schools, please list and explain here):

College / University Name:

College / University Address:

Years of Attendance (Lowest to Highest, example: 2009-2013)

Did you Graduate?

to continue U.S.?

Degree (Please list Degree, Minor, Certificate, example: Major in Fire Science; Minor in Emergency Medicine):

References

Please complete all information for three references of your selection.

Reference #1 Full Name

Company Name:

Relationship:

Professional (Supervisor / Manager, Coworker / Colleague, Subordinate / Direct Report). Educational (Instructor, Professor, Advisor) Personal (Family Friend, Person that knows you best).

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference # 2 Full Name

Relationship:

Professional (Supervisor / Manager, Coworker / Colleague, Subordinate / Direct Report). Educational (Instructor, Professor, Advisor) Personal (Family Friend, Person that knows you best).

Company Name:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference #3 Full Name

Relationship:

Professional (Supervisor / Manager, Coworker / Colleague, Subordinate / Direct Report). Educational (Instructor, Professor, Advisor) Personal (Family Friend, Person that knows you best).

Company Name:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employment History

Please list your three most recent employers.

Employer 1:

Employer 1 Address:

Street Number, Street Name, City, State, Zip Code

Employer 1 Phone Number:

Employer 1 Supervisor (Please include phone number for supervisor):

Employer 1 Job Title:

Employer 1 Salary (Please list starting and ending salaries if applicable):

Employer 1 Roles / Responsibilities:

Employer 1 Term of Employment (Please include estimated start date):

Employer 1 Reason for leaving:

Employer 2:

Employer 2 Address:

Street Number, Street Name, City, State, Zip Code

Employer 2 Phone Number

Employer 2 Supervisor (Please include phone number for supervisor):

Employer 2 Job Title:

Employer 2 Salary (Please list starting and ending salaries if applicable):

Employer 2 Roles / Responsibilities:

Employer 2 Term of Employment (Please include estimated start date):

Employer 2 Reason for leaving:

Employer 3:

Employer 3 Address:

Street Number, Street Name, City, State, Zip Code

Employer 3 Phone Number

Employer 3 Supervisor (Please include phone number for supervisor):

Employer 3 Job Title:

Employer 3 Salary (Please list starting and ending salaries if applicable):

Employer 3 Roles / Responsibilities:

Employer 3 Term of Employment (Please include estimated start date):

Employer 3 Reason for leaving:

Fire / EMS Service

Fire / Emergency Medical Services

Company Name:

Years of Service (Lowest to Highest; example: 2000-2002; 2000-Present):

Chief's Name:

Chief's Phone Number:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Digital Signature (Please enter your name)

By signing this document, you acknowledge and certified that all information filled out is correct. Any misrepresentation may result in disqualifying chances for employment with our organization.