JOIN OUR TEAM - Employment Interest Form

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EMS EMPLOYMENT INTEREST FORM

Thank you for your interest in a position at EMS.

Please complete the form below and our team will reach out with further instructions.

Name*

First Name*

Initial (optional)

Last Name*

Current Address*

Address Line 1

City

State

ZIP Code

Phone*

Email Address

LOCATION

Please indicate your location preference(s):*

(select all that apply)

Indiana City Preference(s)*

Bloomington Carmel / Westfield Columbus Crawfordsville Fishers Ft. Wayne Indianapolis Lafayette Mishawaka Muncie Noblesville Pike South Bend Valparaiso Warsaw

(mark all that apply)

Missouri City Preference(s)*

Brentwood Bridgeton Chesterfield Clayton Columbia Hazelwood Joplin Kirkwood Maryland Heights Rolla Springfield St. Charles St. Louis St. Peters Troy Weldon Spring Wentzville

(mark all that apply)

Michigan City Preference(s)*

Grand Rapids Lansing Okemos

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Virginia City Preference(s)*

Lynchburg Roanoke

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Utah City Preference(s)*

Lynchburg Roanoke

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Washington City Preference(s)*

Seattle

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Nevada City Preference(s)*

Las Vegas

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Montana City Preference(s)*

Missoula

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Louisiana City Preference(s)*

Baton Rouge Lafayette Shreveport

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Oklahoma City Preference(s)*

Tulsa

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Iowa City Preference(s)*

Cedar Rapids

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Colorado City Preference(s)*

Aurora Denver Empire Fort Collins Heeney Highlands Ranch Leadville Lone Tree Pueblo

(mark all that apply)

Arkansas City Preference(s)*

Little Rock Northwest Arkansas River Valley

(mark all that apply)

Illinois City Preference(s)*

Bloomington Effingham Elgin Elk Grove Village Pontiac

(mark all that apply)

Georgia City Preference(s)*

Adairsville Albany Atlanta Bainbridge Calhoun Chatsworth Chickamauga Dalton Fitzgerald Lafayette Ringgold Thomson Savannah Valdosta

(mark all that apply)

Alabama City Preference(s)*

Andalusia Birmingham Mobile

(mark all that apply)

Nebraska City Preference(s)*

Lincoln Omaha

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New York City Preference(s)*

Pittsford Rochester Watertown

(mark all that apply)

Maryland City Preference(s)*

Thurmont

(mark all that apply)

Delaware City Preference(s)*

Newark

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New Jersey City Preference(s)*

Secaucus West Caldwell

(mark all that apply)

Texas City Preference(s)*

Austin College Station Corpus Christi DFW Airport Area El Paso Houston Irving Jacksonville Laredo Longview Lubbock Plano Richardson San Angelo San Antonio

(mark all that apply)

Pennsylvania City Preference(s)*

Altoona Bethlehem Bridgeville Butler Canonsburg Carlisle Chambersburg Danville Easton Ephrata Gettysburg Greensburg Hanover Harrisburg Hendersonville Huntingdon New Kensington Lancaster Lewistown Limerick Mechanicsburg Pittsburgh (Airport Area) Scranton Smithfield Southpointe State College Stroudsburg Uniontown / Smock Wilkes-Barre York

(mark all that apply)

Kansas City Preference(s)*

Garden City Great Bend Hutchinson Kansas City Lenexa McPherson Pratt Salina Topeka Wichita

(mark all that apply)

Florida City Preference(s)*

Bradenton Clearwater Daytona Doral Jacksonville Lake Mary Lakeland Miami Ocoee Orlando Palatka Pensacola Sarasota St. Pete Tampa Temple Terrace Venice Winter Haven

(mark all that apply)

Arizona City Preference(s)*

Globe Morenci Phoenix Safford Tucson

(mark all that apply)

New Mexico City Preference(s)*

Albuquerque Silver City Flexible

(mark all that apply)

Ohio City Preference(s)*

Bucyrus Cambridge Cincinnati Downton Cincinnati Area Clayton County Area Columbus Area Dayton Dayton Surrounding Areas Downtown Fairfield Lima Mason Mentor Middletown Minster Mt. Hope Painsville Van Wert West Chester Zanesville

(mark all that apply)

Kentucky City Preference(s)*

Corbin Covington Danville Elizabethtown Erlanger Florence Georgetown Lexington Louisville Mt. Sterling Newport Nicholasville Richmond Winchester

(mark all that apply)

North Carolina City Preference(s)*

Bryson City Charlotte Franklin Lexington

(mark all that apply)

South Carolina City Preference(s)*

Aiken Charleston (North) Clemson Clinton Columbia Elgin Fountain Head Greenville

(mark all that apply)

Tennessee City Preference(s)*

Chattanooga Clarksville Franklin Johnson City La Vergne Lebanon Manchester Maryville Murfreesboro Nashville Shelbyville Smyrna South Pittsburg Spring Hill

(mark all that apply)

Wisconsin City Preference(s)*

Appleton Elm Grove Madison Milwaukee Sheboygan

(mark all that apply)

Minnesota City Preference(s)*

Alexandria

(mark all that apply)

GENERAL INFORMATION

Employment Desired*

Full-Time Part-Time Temporary

Please indicate your availability:*

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

(mark all that apply)

Please indicate your availability by checking the boxes below:*

Day Shift Night Shift Weekend Shift Flexible

(mark all that apply)

Date available to start:*

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Month

Day

Year

Do you have a reliable method of transportation?*

Yes No

Do you have the legal right to work in the United States of America?*

Yes No

Where did you hear about this position?

Online Job Site Newspaper / Classifieds Local Career Center / Job Fair Facebook Posted Flyer A Friend or Family Member

Other: Other Value

Executive Management Services, Inc. and Affilated Companies Online Privacy Policy Your privacy is important to us. To help protect your privacy, Executive Management Services, Inc. and its affiliated companies (collectively identified as “We,” “Us” or “Our” herein) provide this notice explaining our online information practices and the choices you can make about the way your information is collected and used. This notice applies to all information collected or submitted on Our website at www.emsinc.com. • The only personal information We collect is information that is submitted through the online employee application. This may include private information such as your legal name, street and email address, telephone number, and information relating to criminal background investigations. We do not, at any time, collect any financial information or ask or request a credit card number or other information involved in completing a financial transaction. • We use the personal information collected from you to for the purposes of assessing applications for employment. Such personal information as we collect is not used for any other purpose and is not shared with any organization not directly owned by or affiliated with Executive Management Services, Inc. • We never use or share the personally identifiable information provided to Us online in ways unrelated to the ones described above. • To prevent unauthorized access, maintain data accuracy, and ensure the correct use of information, We have put into place appropriate physical, electronic, and managerial procedures to safeguard and secure the information We collect online. • Protecting the privacy of the very young is especially important. For that reason, We never collect or maintain information at our website from those We actually know are under the age of 13, and no part of our website is structured to attract anyone under 13 to provide information to Us. • You can correct factual errors in your personally identifiable information by sending Us a request detailing the error(s). To protect your privacy and security, We will also take reasonable steps to verify your identity before granting access or making corrections. • In the unlikely event any of the personal information you supply us online is misused, you may redress these issues by contacting us directly at hrgeneral@emsinc.com. Should you have questions or concerns about this Privacy Policy, please call us at 317-594-6000.