Online Application

Position Desired*

Preferred Schedule Status*

Full-Time

Part-Time

Check all that apply.

Preferred Work Location(s)*

Fullerton

Irvine

Orange

Mission Viejo

Laguna Beach

Check all that apply.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Phone*

Primary Phone Type*

Home (Landline Phone)

Mobile (Cell Phone)

Secondary Phone

Secondary Phone Type

Home (Landline Phone)

Mobile (Cell Phone)

Email*

Enter Email Confirm Email

Have you ever worked for Shoreline Ambulance (or AmbuServe, Inc.) before?*

Yes

No

If yes, please give dates, position and reason for leaving:

How did you become aware of Shoreline Ambulance?*

If referred by a Shoreline employee, please provide the employee's first and last name:

Have you ever pled guilty or "no contest" to, or been convicted of, a misdemeanor, felony, or any type of moving violation?*

Yes

No

If yes, please give the date(s) and details:

Have you been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial?*

Yes

No

If yes, please give the date(s) and details:

NOTE: Answering “Yes” to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic infractions, and convictions for which the record has been sealed or expunged, any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pretrial or post trial diversion programs, and marijuana-related offenses that occurred over two years ago in answering these questions).

RECORD OF PREVIOUS EMPLOYMENT
Please list the names of your present and/or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references.

Employer #1

Employer Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

Still Employed?

Yes

No

If no, provide final date of employment

Your Job Title & Position

Name and Title of Last Supervisor

Reason for Leaving

Additional Employment Record?

Yes

Employer #2

Employer Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

Final Date

Your Job Title & Position

Name and Title of Last Supervisor

Reason for Leaving

Additional Employment Record?

Yes

Employer #3

Employer Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

Final Date

Your Job Title & Position

Name and Title of Last Supervisor

Reason for Leaving

Additional Employment Record?

Yes

Employer #4

Employer Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

Final Date

Your Job Title & Position

Name and Title of Last Supervisor

Reason for Leaving

Additional Employment Record?

Yes

Employer #5

Employer Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

Final Date

Your Job Title & Position

Name and Title of Last Supervisor

Reason for Leaving

Additional Employment Record?

Yes

Employer #6

Employer Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

Final Date

Your Job Title & Position

Name and Title of Last Supervisor

Reason for Leaving

EDUCATION BACKGROUND

High School Name*

(If you attended more than one, indicate the high school you most recently attended.)

High School Location

City State / Province / Region

Start Date

Final Date

Highest Grade Completed*

Diploma (or equivalent) Received?

College / University

Did you attend a college or university?

Yes

College/University Name

College/University Location

City State / Province / Region

Start Date

Final Date

Course of Study or Major

Years Completed

Degree or Certificate Received

Did you attend a another college or university?

Yes

College/University Name

College/University Location

City State / Province / Region

Start Date

Final Date

Course of Study or Major

Years Completed

Degree or Certificate Received

Graduate / Professional

Did you attend a graduate or professional school?

Yes

School Name

School Location

City State / Province / Region

Start Date

Final Date

Course of Study or Major

Years Completed

Degree or Certificate Received

Trade or Correspondence

Did you attend a trade or correspondence school?

Yes

School Name

School Location

City State / Province / Region

Start Date

Final Date

Course of Study or Major

Years Completed

Degree or Certificate Received

Other Education

Did you attend any other educational program or school relative to the position you are applying for?

Yes

School Name

School Location

City State / Province / Region Country

Start Date

Final Date

Course of Study or Major

Years Completed

Degree or Certificate Received

Personal References

Please list persons who know you well – Exclude previous employers or relatives

Name*

Relation*

Phone*

Email*

Occupation*

Number of Years Known*

Name*

Relation*

Phone*

Email*

Occupation*

Number of Years Known*

Name*

Relation*

Phone*

Email*

Occupation*

Number of Years Known*

Field positions require you to lift a minimum of 170 lbs.

Is there any reason you might not be physically capable of performing this job?*

Yes

No

I am not applying for a field position.

If yes, please explain:

Please upload your resume, cover letter, and each of the applicable credentials for the position you are applying for below.

Resume and/or Cover Letter

Drop files here or

Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, , Max. file size: 4 MB.

California Driver's License or California ID

Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 4 MB.

High School Diploma, GED, or California Certificate of Proficiency