Absolute Safety - where your safety is our priority

First Name:
Last Name:
Middle Initial:

Your mailing address information:
Address (1):
Address (2):
City:
State:
Zipcode:
Country:

Email Address:
Home Phone No.
Mobile Phone No.
Social Security No.	(optional)

Current Employer:
Employer Phone No.
Years With Employer:
May We contact your current employwer?	Yes No

Years as an EMT
EMT level
EMT State Cert. No.
EMT National Registry No.

Your Rescue Qualifications:
Rope:
Ice:
Water:
Swiftwater:
High Angle:
Mountain:
Air:
Confined Space:
WALS:
WEMT:
Scuba:

Education level:
Other level:

Brief work experience:
Other experience relevant to the desired position:
Why are you good for the position?