12351 Randolph Ridge Lane, Manassas, VA 20109
  • 1-800-442-9700

Employment Application | Atlantic Emergency Solutions

  • In addition to completing this application, any supporting materials, such as a resume, may be emailed via attachment to rreed@atlanticemergency.com.
  • Qualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, marital status, veteran status, disability, or any other status protected by law.
  • Items marked with a star (*) indicate required fields.

Employment Application

General Information

Education and Training

Training Beyond High School

Employment History (Most recent first)


Name Contact Information Relationship (Co-Worker, Former Supervisor etc.)



I certify that the facts set forth in the above employment application (and accompanying resume, if applicable) are true and complete to the best of my knowledge. I understand that any false statements, omission, or misrepresentation on this application shall result in disqualification from further consideration for hire or for dismissal if employed after being hired.

I understand that Atlantic Emergency Solutions will thoroughly investigate any information given to them during the application and selection process. I authorize any former employer(s), law enforcement agency, educational institution or any person or organization to provide information about me and release all concerned from all liability in connection therewith.

I understand that my employment with Atlantic Emergency Solutions is conditioned upon being physically able to perform the essential functions of the job applied for, with or without reasonable accommodation, and to that end, I agree to submit to a post offer medical examination and such further medical examinations as may be required. Failure to pass such examinations may result in the revocation of my employment offer.

I further agree that, if employed, my employment can be terminated with or without cause, and with or without notice, at any time, at either the company’s or my option. I understand that any employment manuals or handbooks that may be distributed to me during the course of my employment shall not be construed as a contract either expressed or implied.