top of page

Hardy County Emergency Ambulance Authority
Job Application for Medical Providers

HCEAA Job Application for Medical Providers
By completing and submitting this application, I realize and agree to the following elements of employment if I am offered and accept a position. Please initial each item:
Have you ever been convicted of any crime that would prevent you from being employed in the healthcare field under state or federal law?
Are you willing to work assigned schedule and other hours as asigned?

(Copy of drivers license and identification for I-9 employment verification will be required at time of job offer and prior to starting training)

Education:

(Please list from high school or GED program to current)

Employment History:

Current EMS Training (copies required at time of employment):
Tranings other (copies required at time of employment): Check all that apply

REFERENCES:

(Please list past employers first then if needed due to limited employers you may list personal references but they may not be family members or persons living in your household). PLEASE LIST FOUR (minimum of three)

LIST ALL RELATED VOLUNTEER POSITIONS:

LIST OTHER SPECIAL SKILLS/OTHER:

(Relevant to the position for which you are applying)

I agree by signing and submitting this application that all information is accurate- and that no information has been falsified or omitted and I authorize the agency to complete record checks and background screening for the purpose of determining eligibility for employment to include completing a E-VERIFY AS REQUIRED BY LAW. 

SUBMIT APPLICATION BELOW OR MAIL APPLICATION TO:

​

THE HARDY COUNTY EMERGENCY AMBULANCE AUTHORITY 

PO BOX 217, MOOREFIELD, WV  26836 

Attn: Executive Director 

I am applying for the following position (check all your qualify for and are interested in)

Thanks for applying with HCEAA! We'll get back to you soon.

bottom of page