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Tidewater Medical Transport Employment Application

For consideration for employment, please fill out this application. It is recommended that you also include a resume at the bottom of this form for additional job history. 3 recommendations must be included and uploaded at the bottom of this form. If you have any questions please contact us via the chat button.

General Information

___________________________________________________________________

Address

___________________________________________________________________

Birthday
Month
Day
Year

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US Citizen
Yes
No
If no, are you authorized to work in the US
Yes
No

___________________________________________________________________

Have you ever been convicted of a felony?
Yes
No

Please be as specific as possible including if you are currently on parole, when, ect

Have you ever been convicted of a misdemeanor?
Yes
No

Please be as specific as possible and include when.

Have you ever been convicted of reckless driving or driver under the influence of alcohol or drugs?
Yes
No

___________________________________________________________________

Valid Drivers License?
Yes
No

Certifications

State

___________________________________________________________________

___________________________________________________________________

State

Education

Did you graduate?
Yes
No

___________________________________________________________________

Did you graduate?
Yes
No

___________________________________________________________________

Did you graduate?
Yes
No

Employment History

___________________________________________________________________

Disclaimer and Signature

I hereby certify that the information I provided, to the best of my knowledge in this document are true. If an offer of employment is extended to me I understand that: any information found to be false, or if background investigation identifies any serious criminal offenses or major motor-vehicle infractions, resulting in criminal convictions, may be cause for my dismissal or denial of future employment with Tidewater Medical Transport, Inc. I hereby authorize, Tidewater Medical Transport, Inc. to investigate any information I provided in this document including, but not limited to: a National Criminal Background Check, Sex-Offender Registry, Motor-Vehicle Report (MVR), & a ten-panel Drug Screening. Furthermore, I understand that if I am hired, my employment with Tidewater Medical Transport, Inc. is at will and both employee/employer have the right to terminate employment, for any reason, without any prior notice and is not prohibited under State, Local, or Federal Laws.

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© 2025 by Tidewater Medical Transport, Inc.  All rights reserved.

To Schedule An Appointment

Call 757.399.0999​

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