- EMS Saudi Arabia

Last Name * First Name * Middle Name

Nationality *

Gender *

Age

Status *

Do you have children?
Yes
No

If yes, How many?

Passport No *

Country *

City * Postal code * Telephone *

Present Address (Street & Number) *

Email Address *

Drivers License Number *

State/Country * Expiration *

Height *
Weight *

I certify that I have NO physical, mental, or medical condition that would render me incapable of performing the duties for which I am applying. *

In Case OF Emergency Please Notify:

Name Relationship Address Phone Email Address Mobile Phone

Position Applying For: *

1.

2.

Salary Required *

Do You Plan TO Have Your Family Accompany You? *

Currently Employed? *

Can WE Contact Your Present Employer? *

Date Available For Work *

Branch OF Service * Date Entered *

Date Discharged * Rank AT Discharge *

Nature OF Duties And Secial Training Received *

Please indicate any educational, vocational, on-the-job, or any other training you have received which will aid us in placing you in the position that best meets your qualifications and/or in determining your qualifications for a position for which you desire to be considered.
High School Name And Location * Degree AND/OR Training RCVD * MAJOR / MINOR *

College Training *

Graduate School

Other Schools OR Special Training, Including Languages OR Other Skills

State OR National Registry ID

Number Registered Since Expiration Date

Currently STATE/COUNTRY Certified, Licensed, OR Registared?
Yes
No

Registering Body

List All Degree’s Diploma’s, Licensure’ Certifications With Dates Completed: *

Have You Ever Been Convicted OF A Felony? *

EXPLAIN (CONVICTION WILL NOT NECESSARILY BAR EMPLOYMENT) *

WORK EXPERIENCE

Start with your present or last position and work back accounting for all periods of employment.

PRESENT / LAST EMPLOYER *

NAME OF EMPLOYER * TYPE OF BUSINESS * ADDRESS * STARTED
MM/YY * LEFT
MM/YY * STARTING
PAY FINAL
PAY NAME AND TITLE OF SUPERVISOR * TELEPHONE * JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES * REASON FOR LEAVING

PREVIOUS EMPLOYER (1)

NAME OF EMPLOYER TYPE OF BUSINESS ADDRESS STARTED
MM/YY LEFT
MM/YY STARTING
PAY FINAL
PAY NAME AND TITLE OF SUPERVISOR TELEPHONE JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES REASON FOR LEAVING

PREVIOUS EMPLOYER (2)

NAME OF EMPLOYER TYPE OF BUSINESS ADDRESS STARTED
MM/YY LEFT
MM/YY STARTING
PAY FINAL
PAY NAME AND TITLE OF SUPERVISOR TELEPHONE JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES REASON FOR LEAVING

PREVIOUS EMPLOYER (3)

NAME OF EMPLOYER TYPE OF BUSINESS ADDRESS STARTED
MM/YY LEFT
MM/YY STARTING
PAY FINAL
PAY NAME AND TITLE OF SUPERVISOR TELEPHONE JOB TITLE AND DESCRIPTION OF DUTIES AND RESPONSIBILITIES REASON FOR LEAVING

Please indicate the procedures for which you are currently accredited to use within your country/state/service. *
(Minimum of selection is one selection.)

Airway:

Laryngeal Mask Airway

Endotracheal Intubation

Oral / Nasopharyngeal Airway

Cricothyroidotomy

Defibrillation:

Semi-Automatic

Manual

Sync. Cardioversion

Other:

Needle decompression

Surgical Airway

Cardiac Monitoring

12 lead interpretation

Pulse Oximetry

Capnography

Automatic Ventilators

Infusion Pumps

Rapid Sequence Intubation

Crystalloid fluid infusion

Drug Administration:

Intramuscular Injection

Intravenous Injection

Intraosseous

Intravenous Cannulation

Other:

Medications:

Adrenaline (for anaphylaxis)

Adrenaline(nebulized for Croup)

Adrenaline (Cardiac)

Amiodarone

Aspirin (cardiac/chest pain)

Atropine

Dextrose 5%

Dextrose 50%

Diazepam (IV for seizures)

Fentanyl Citrate (pain control)

Furosimide

Glucagon

Nitroglycerin (hypertension)

Nitroglycerin (chest pain)

Nitroglycerin (CHF)

Hydrocortisone

Ipratropium Bromide

Lidocaine

Magnesium Sulphate

Midazolam

Lorazapam

Morphine

Naloxone

Paralytics for intubation

Potassium Chloride

Phenergan

Proventil

Sodium Bicarbonate

Other:

Affidavit

I certify that the information given by me in this application is correct and without consequential omissions and understand that any misstatement or omission will void this application and is grounds for dismissal. I authorize any company, school, or other institution or person to release any information regarding my employment, character, qualifications or health and release all parties from all liability for any damage that may result from furnishing same to you. In consideration of my employment, I agree to conform to the rules and regulations of the Saudi Red Crescent Authority, and my employment and compensation can be terminated with or without cause, and with or without notice, at any time at the option of either the Company or myself. I further understand that no manager or representative of the Saudi Red Crescent Authority, other than the Administrator, has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing. I understand that in order to be selected for employment, I must agree to submit to a pre-employment physical exam and test. These shall include, but are not limited to, a physical exam, x-ray, tuberculosis skin test, urinalysis, and blood test to determine the presence of contagious diseases, chemical dependency, etc. I further understand that the results of the exam and tests shall be submitted to the employer for evaluation and must satisfy the standards set by the employer before I can be considered for employment.

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