Rescue 1 Paramedic Services LLC
221 W. Madison St.
Chrisman, IL 61924
217.269.3911 Dispatch
217.269.2242 Fax
Employment Application
Rescue 1 Paramedic Services LLC
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  • Contact Information

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  • Yes No
    Can you provide proof of elgibilty to work in the United States?
    Have you ever been convicted of a Felony?
    Have you been convicted for any crime?
    Do you have any pending criminal charges against you?
  • Have you ever served with the US Military?
    If yes, Which Branch, Dates of Service?
  • License Number: Expiration Date:
    ACLS
    Bloodborne Pathogens
    CDL
    CPR
    EMD
    EMT-Basic
    EMT-Intermediate
    EVOC
    First Responder
    Hazmat Awareness
    Hazmat Operations
    ITLS
    PALS
    Paramedic
    Pre-Hospital RN
  • YES NO
    ICS 100
    ICS 200
    ICS 300
    ICS 400
    ICS 700
    ICS 800
  • Name/City/State Graduate
    High School
    College
    Other School
    Other School
  • Company Name City/State Dates of Employment Job Title Ending Wage Supervisors Name Reason for Leaving May we contact this Employer? Yes/No
    Current/Most Recent Employer
    Previous Employer
    Previous Employer
    Previous Employer
    Previous Employer
    Previous Employer
  • Name Occupation Years known Phone Number
    Reference 1
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