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• Full name✱
• Email✱
• Phone ✱
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• Current company

EMT Qualification Questions

• Are you at least 18 years or older? (For insurance purposes)✱

  • Yes
  • No
• Do you have an ACTIVE EMT Certification in the State of California? (Applied via County EMS Agency)✱

  • Yes
  • No
• If you answered "Yes" to the previous question, when did you submit your county application?
• Do you have a valid and active CPR card administered by the American Heart Association?✱

  • Yes
  • No
• Do you have a valid Ambulance Drivers License administered by the CA Department of Motor Vehicles?✱

  • Yes
  • No
• Please indicate the FEMA/NFPA courses completed below: (Free independent study course provided by FEMA at www.fema.gov)✱

  • ICS - 100
  • ICS - 700
  • AWR 160
  • Courses still in progress (Please select which courses are completed above)
• Lifting Requirement: Can you successfully lift and/or move at least 150 pounds frequently and successfully lift and/or move up to 200lbs occasionally?✱

  • Yes
  • No
• Can you perform the job, with or without a reasonable accommodation?✱

  • Yes
  • No
• What EMT Program did you complete?✱

  Select OneAmerican Health EducationBay Area Training AcademyBay EMT/Merritt CollegeBerkeley Adult SchoolChabot CollegeCity College of San FranciscoCollege of MarinDefibThis BerkeleyDefibThis Santa CruzEMS CorpsOnsite Medical ServicesFoothill CollegeMission CollegeSan Jose City CollegeNCTIProject HeartbeatLas Positas CollegeContra Costa CollegeSilicon Valley AmbulanceSolano CollegeCollege of San MateoCabrillo CollegeRC Health ServicesSkyline CollegeNapa Valley CollegeUC Davis EMTOther [Please Specify]
• If Other, please enter below:
• Referral Source✱

  Select OneIndeedFacebook/InstagramGlassdoorGoogleLinkedInReferred by Royal Team Member [Please list referral below]School or CollegeYoutubeWalk-in or Drive-ByOther Source
• If Referred by an Employee or Other, please enter information below:
• What are your career goals?✱

  Select OneFirefighterFirefighter and/or ParamedicFlight MedicFlight NurseNurse PractitionerParamedicPhysicianPhysician AssistantPoliceRegistered NurseOther/Exploring
• If Other, please enter below:
• Have you completed a Ride-Along with Royal?✱

  • Yes
  • No
• Have you attended a Royal Ambulance presentation/informational?✱

  • Yes
  • No
• What is the earliest date you can start?✱
• Are you legally authorized to work in the United States?✱

  • Yes
  • No

Military Service (If Applicable)

• Branch

  Select...ArmyMarine CorpsNavyAir ForceSpace ForceCoast Guard
• Currently Active? If not, please fill out dates of service in the following field.

  • Yes
  • No
• Dates of Service: (Month/Year)-(Month/Year)
• Rank at Discharge:
• Type of Discharge:

  Select...Honorable dischargeGeneral Discharge Under Honorable ConditionsOther Than Honorable (OTH) dischargeBad Conduct discharge (issued by special court-martial or general court-martial)Dishonorable dischargeEntry-level SeparationMedical SeparationSeparation for Convenience of the Government
• If other than honorable, please explain:

COVID Vaccination Requirements

• Are you FULLY vaccinated against the COVID-19 Virus?✱

  • Yes
  • No
• If you answered "Yes" to above, please indicate below if you've received the COVID-19 Booster:✱

  • I have received the booster (3rd vaccination)
  • I have not received the booster
  • I am planning to schedule a booster shot
• If you are not vaccinated against the Covid-19 Virus, are you willing to receive the vaccination as a condition of your employment at Royal?

  • Yes
  • No
• If the answer to your prior questions was "NO" because you require an accommodation please contact Royal’s Human Resources team via email at HR@royalambulance.com.

  • I will contact Royal Ambulance's HR Team for further instruction.

Demographic Survey for Royal Ambulance

We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.

• What is your age range?
  • 17 or younger
  • 18-20
  • 21-29
  • 30-39
  • 40-49
  • 50-59
  • 60 or older
• I identify my ethnicity as

  Select all that apply

  • White / Caucasian
  • Hispanic, Latino, or Spanish origin
  • Black or African American
  • Asian
  • Native Hawaiian or other Pacific Islander
  • Indigenous Peoples, First Nations, Native American, or Alaska Native
  • Middle Eastern or North African
  • Some other race, ethnicity, or origin
• Gender Status

  Our company does not discriminate on the basis of gender identity or expression. In order to track the effectiveness of our recruiting efforts and ensure we consider the needs of all our employees, please consider the following optional question: What is your gender?

  • Female
  • Male
  • Non-binary/Third Gender
  • Prefer to self-describe
  • Prefer not to say
• Sexual Orientation

  Our company does not discriminate on the basis of sexual orientation, gender identity or expression. In order to track the effectiveness of our recruiting efforts and ensure we consider the needs of all our employees, please consider the following optional question: What is your sexual orientation?

  • Straight/Heterosexual
  • Gay or Lesbian
  • Bisexual
  • Prefer to self-describe
  • Prefer not to say