Manawa Rural Fire and Ambulance

Looking for EMT's or EMT Intermediates

If you are interested in applying, please cut and paste the form below, fill in, and mail to the Manawa Rural Fire and EMS at PO Box 953 Manawa, WI  54949 or email the completed application to the EMS Director at :  manawaems@wolfnet.net

                 APPLICATION FOR EMPLOYMENT

Name:

Address

Phone:                           Social Security#

Date of Birth                         Age:

Position Applying For:   EMT-IV______EMT______

Please List all Training_________________________________

____________________________________________________

___________________________________________________

Work Experience:

Employer:______________________________________

Address:_______________________________________

Phone Number: ______________Supervisor________________

Date of Employment______________________________

Reason For Leaving_________________________________

Reason For Leaving_________________________________

Work Experience:

Employer:______________________________________

Address:_______________________________________

Phone Number: ______________Supervisor________________

Date of Employment______________________________

Date of Employment______________________________

Reason For Leaving_________________________________

Work Experience:

Employer:______________________________________

Address:_______________________________________

Phone Number: ______________Supervisor________________