Join Us

Name (First Middle Last)

Date of Birth

Sex
MaleFemale

Address (Street, City, State, Zip)

Phone Number

Email

If under 18, what high school do you attend? Grade, and year of graduation.

Primary Emergency Contact Full Name, Phone Number, Cellphone Number

Secondary Emergency Contact Full Name, Phone Number, Cellphone Number

Are you in good physical condition?
YesNo

Drivers License Number, State, and Expiration

Have your driving privileges ever been suspended or revoked in any state?
YesNo

EMT State, Number, and Expiration (if applicable)

CPR Certification Type, and Expiration (if applicable)

Have you ever had any professional licenses suspended in any state?
YesNo

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed; misstatement of fact, omissions, or attempts to mislead the agency, either deliberate or in error, may lead to disqualification or termination at any time.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

Our agency adheres to a policy of Employment-at-Will which allows either party to terminate the employment relationship at any time, for any reason, with or without cause or notice.

I also understand and agree that no representative of the agency has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing unless it is in writing and signed by an authorized agency representative.

I further authorize a full background check with fingerprinting to be conducted by Mount Olive Police.

I understand that as an "employee" you will not be financially compensated.

I understand that I am expected to uphold all standards and policies that will be provided to me upon the date of appointment.

By clicking you agree to all of the above statements with this checkbox constituting as your signature.