Chesapeake Medical Transport Services
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About Us

Chesapeake Medical Transport, LLC was formed in 2017, to provide quality medical and mobility transportation in the Southern Maryland Region. 

Chesapeake prides itself on providing prompt and professional care for our patients and clients. 

Chesapeake offers: Advanced Life Support, Basic Life Support and Wheelchair/Mobility services throughout the State of Maryland.    

 

Employment Application

Required   Indicates Required Field
APPLICANT INFORMATION
Last Name: Required
First Name: Required
Middle Initial: Required
Street Address: Required
City, State, Zip Code: Required
Email Address: Required
Social Security Number:
Date of Birth: Required
Home Phone:
Cell Phone:
Are you a US Citizen?: Required
Authorized to work in US?: Required
Position Desired: Required
Hours Requested:
Select all that apply
Required
Date Available: Required
Desired Salary:
EMPLOYMENT QUESTIONS
Have you ever been Employed at Chesapeake Medical Transport Services before: Required
If Yes, List Dates:
Do you have any friends or relatives that work at Chesapeake Medical Transport Services?: Required
If Yes, Who?:
Have you ever been convicted of a crime? : Required
If Yes, Explain:
Do you have any physical, mental, or medical impairments which may limit your ability to perform job related duties?: Required
If Yes, Please explain:
How did you hear about Chesapeake Medical Transport Services?: Required
CERTIFICATIONS / LICENSES
Currently an NREMT?: Required
PSC License?: Required
Do you have EVOC?: Required
CDL License?: Required
Highest level of Medical Certification: Required
Certification #1:
List Certification Type, State and Certification #
Certification #2:
List Certification Type, State and Certification #
Certification #3:
List Certification Type, State and Certification #
Driver's License #: Required
State Issued: Required
Do you have points on your driving record?: Required
If so, how many? :
EDUCATION
High School attended : Required
High School Location (City/State): Required
Did you graduate or receive a GED?: Required
Date graduated, or received GED:
Higher Education #1:
College or University, Location (City/State), Dates attended and Major or Degree awarded
Higher Education #2:
College or University, Location (City/State), Dates attended and Major or Degree awarded
Higher Education #3:
College or University, Location (City/State), Dates attended and Major or Degree awarded
PERSONAL REFERENCES
Reference #1:
Full Name, Occupation, Address, City, State, Zip, Relationship, Home Phone, Cell Phone,Email
Required
Reference #2:
Full Name, Occupation, Address, City, State, Zip, Relationship, Home Phone, Cell Phone,Email
Required
Reference #3:
Full Name, Occupation, Address, City, State, Zip, Relationship, Home Phone, Cell Phone, Email
Required
EMPLOYMENT HISTORY
Company Name - Employer #1: Required
Address - Employer #1: Required
Supervisor - Employer #1: Required
Phone Number - Employer #1: Required
Job Title - Employer #1: Required
Salary - Employer #1: Required
Dates Employed - Employer #1: Required
Reason for leaving - Employer #1: Required
Company Name - Employer #2:
Address - Employer #2:
Supervisor - Employer #2:
Phone Number - Employer #2:
Job Title - Employer #2:
Salary - Employer #2:
Dates Employed - Employer #2:
Reason for leaving - Employer #2:
Company Name - Employer #3:
Address - Employer #3:
Supervisor - Employer #3:
Phone Number - Employer #3:
Job Title - Employer #3:
Salary - Employer #3:
Dates Employed - Employer #3:
Reason for Leaving - Employer #3:
VOLUNTARY DISCLOSURE: Required Accept Voluntary Disclosure
Decline Voluntary Disclosure




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Chesapeake Medical Transport Services
3221 Old Washington Rd
Waldorf, MD 20602
Emergency Dial 911
Office: 240-754-7870
Fax: 240-448-3609
E-mail: info@choosecmts.com
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