EMS Application

The information requested on this questionnaire is for the use of the City of Eagle Grove E.M.S., to assist in the determination of your suitability for the position of:  EMT or Driver. All questions must be answered completely. Any intentional omission or alteration of facts can be grounds for dismissal if hired, or removal from further consideration.

By your request heron, you grant all rights to the City of Eagle Grove, or the designated agents thereof, to fully investigate all information provided by you on this questionnaire. This shall include, but not limited to, contacting selected or all persons named by you on this questionnaire and inquire as to your character, work performance, personality, and other considerations deemed necessary by the City of Eagle Grove.

Also, by your signature hereon, you waive the right to review any, and all information gathered in the course of the investigation as well as release the City of Eagle Grove, its designated agents, and all persons connected with the investigation, from all liability, which may be brought about by said investigation.

* - denotes required field