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Gates County Rescue & EMS

People Helping People Since 1964

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Application

Application

  • Please be aware that Rescue & EMS Public Safety work requires a very high level of attention to detail as well as the ability to document your work. This form is used as an evaluation of your ability to complete required documentation. The information requested in this application is the minimum needed information for us to began the process of considering your eligibility for employment and/or volunteer work with our agency. In order for your application to be considered all of the information requested on this form must be completed. Thank you,
  • Use the + button on right to make additional entries.
    LevelName/LocationDatesField/Diploma/Degree 
  • CPR, Tech Rescue, EMT, EVD, RN, MD, etc. Use the + button on the right to make additional entries.
    Certifications or Licenses HeldDate Issued – Date ExpiresState Issued From 
  • Please list/describe any special certifications, skills, or previous emergency experience that you have or extracurricular activities that you do that are relevant to your being a member of GCRS. For certifications, please include dates of expiration.
  • List a minimum of five years, from most recent to least. Use the + button to the right to make additional entries.
    Employer NameAddressPrevious PositionDates Employed from (mm/yyyy)Dates Employed to (mm/yyyy)Phone Number 
  • Please list at least 1 references. Who you have worked for in the past that can give a work performance reference on you. You can use the + button to the right to make additional entries.
    NameEmailPhone 
  • Please list at least 1 professional references. This person should not be a family relation to you. You can use the + button to the right to make additional entries.
    NameEmailPhone 
  • Please list at least one personal reference. You can use the + button to the right to make additional entries.
    NameEmailPhone 
  • Use this space to answer or clarify any previous questions, or to provide any additional pertinent information.
  • Please list / describe any medical conditions (including medications) which may prevent or impair your ability to perform various tasks as a member of GCREMS or that we should be aware of in case of an emergency:
  • Check all that apply
  • Drop files here or
    Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 128 MB.
      Please upload electronic versions of any resume or certifications you may have.
    • Reset signature Signature locked. Reset to sign again
      This is to certify that I, the above-signed, freely and voluntarily offers themselves to his fellow man regardless of race, creed, or color. It is to be clearly understood by this applicant that he/she is required to be available for call at any hour, day or night, providing that it does not interfere with his/her work or business. If the applicant is granted membership, he/she will be governed by the constitution and by-laws of this organization. The applicant’s signature on this application grants this organization permission to verify all information and conduct criminal background and DMV history reports. Any information being found falsified will be grounds for denial.
    • This field is for validation purposes and should be left unchanged.

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    GPFH

    Gates County
    Rescue & EMS

    016 U.S. HWY 158 East
    Gatesville, NC 27938
    (252) 357-0388 Office
    (252) 357-0141 Fax
    (252) 357-0210 Dispatch

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