E5 Support Services, LLC
Employment Application

Applying for E5 Support Services is a 3 part process:

  1. Application process – After filling out and submitting this application to the above address, your references and employment history will be checked. Credentials may be verified.

  2. Interview & Evaluation process – After the application process is complete, you will be invited in for an interview & evaluation of skills. Your job description will be explained to you and you will be expected to perform these job tasks as you would in the field. This is not a pass/fail test as it is a rating scale compared to other applicants for your position.

  3. Agency placement – After the first two parts of the process are complete, E5 Support Services will sit down with the contracted agency and verify your abilities, persona and professionalism are a right fit for that agency.


BLS Provider   ALS Provider   Trainer  

Attached to this, you must include:

Accepted files: PDF, JPG/JPEG and PNG. File size 5 MB maximum limit.

Ballston Lake   Castleton   Hague Fire & EMS   Hermon Fire   Massena   Nassau  
North Queensbury   Potsdam   Sand Lake   Schroon Lake   Wellsville  

Sunday (Day)  
Monday (Day)  
Tuesday (Day)  
Wednesday (Day)  
Thursday (Day)  
Friday (Day)  
Saturday (Day)  
Sunday (Night)  
Monday (Night)  
Tuesday (Night)  
Wednesday (Night)  
Thursday (Night)  
Friday (Night)  
Saturday (Night)  

Yes   No


Please list three professional references that we may contact, including at least two past employers.

Physical Record

Yes   No

Yes   No


I certify that the answers herein are true and complete to the best of my knowledge. I understand that false or misleading information given in my application and/or interview(s) is grounds for refusing to hire me, or for discharge should I be hired. I also authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I understand and agree that I may be required to pass one or more of the following: Physical examination, drug screen, respiratory evaluation, credit check and criminal record check, as a condition of hiring or continued employment.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written documentation or by conduct unless an authorized executive of this organization specifically acknowledges such change, in writing.

In the event of employment, I understand, also that I am required to abide by all rules and regulations of the employer.

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