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APPLICATION FOR EMPLOYMENT

"*" indicates required fields

Step 1 of 7

14%
Position Desired*
Emergency Medical Technician
Paramedic
Billing Clerk
EMS Dispatcher
CCT-RN
CCT-RT
Office Clerk/Receiptionist
Administrative Assistant
Field EMS Supervisor
Fleet Mechanic
Preferred Schedule Preference*
Full-Time
Part-Time
Select All
Check all that apply.
Preferred Work Location*
Gardena
East Hollywood
Norwalk
San Pedro
Santa Monica
Torrance
West Los Angeles
Select All
Check all that apply.
Name*
First Last
Address*
Street Address Address Line 2 City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State ZIP Code
Primary Phone*
Primary Phone Type*
Mobile (Cell Phone)
Home Phone (Landline)
Secondary Phone
Secondary Phone Type
Home Phone (Landline)
Mobile (Cell Phone)
SMS Consent
I agree to the SMS Disclaimer.
I consent to receive text messages about scheduling and availability from Ambuserve, Inc. at the phone number I provided. I acknowledge that my consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Reply HELP for assistance or STOP to opt out of receiving messages. Privacy Policy https://www.ambuserveambulance.com/privacy-policy/
Email*
Enter Email Confirm Email
Have you ever worked for AmbuServe before?*
Yes
No
If yes, please give dates and position
How did you become aware of AmbuServe Ambulance?*
Job Posting – Indeed
Job Posting – Zip Recruiter
Job Posting – Craigslist
Social Media Post – Instagram
Social Media Post – Facebook
Social Media Post – TikTok
Social Media Post – Twitter
Social Media Post – YouTube
Referral – EMT School
Referral- EMS Agency
Referral – AmbuServe Employee
Referral – Friend or Acquaintance
AmbuServe Web Site
Other
If referred by an AmbuServe employee, please provide the employee's first and last name:
Have you ever pled guilty or "no contest" to, or been convicted of, a misdemeanor, felony, or any type of moving violation?*
Yes
No

If yes, please give the date(s) and details:
Have you been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial?*
Yes
No

If yes, please give the date(s) and details:
NOTE: Answering “Yes” to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic infractions, and convictions for which the record has been sealed or expunged, any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pretrial or post trial diversion programs, and marijuana-related offenses that occurred over two years ago in answering these questions).
RECORD OF PREVIOUS EMPLOYMENT
Please list the names of your present and/or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references.
Employer #1
Employer Name
Phone
Address
Street Address City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State ZIP Code
Start Date (Month/Year)
Final Date (Month/Year)
Your Job Title & Position
Name and Title of Last Supervisor
Exact Reason for Leaving
Employer #2
Employer
Phone
Address
Street Address City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State ZIP Code
Start Date (Month/Year)
Final Date (Month/Year)
Your Job Title & Position
Name and title of Last Supervisor
Exact Reason for Leaving
Employer #3
Employer
Phone
Address
Street Address City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State ZIP Code
Start Date (Month/Year)
Final Date (Month/Year)
Your Job Title & Position
Name and Title of Last Supervisor
Exact Reason for Leaving
Employer #4
Additional Employment Record?
Yes
Employer
Phone
Address
Street Address City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State ZIP Code
Start Date (Month/Year)
Final Date (Month/Year)
Your Job Title & Position
Name and Title of Last Supervisor
Exact Reason for Leaving
Employer #5
Additional Employment Record?
Yes
Employer
Phone
Address
Street Address City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State ZIP Code
Start Date (Month/Year)
Final Date (Month/Year)
Your Job Title & Position
Name and Title of Last Supervisor
Exact Reason for Leaving
Employer #6
Additional Employment Record?
Yes
Employer
Phone
Address
Street Address City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State ZIP Code
Start Date (Month/Year)
Final Date (Month/Year)
Your Job Title & Position
Name and Title of Last Supervisor
Exact Reason for Leaving

Have you ever been terminated or asked to resign from any job?*
Yes
No

If yes, please explain circumstances:Please fully explain any gaps in your employment history:
May we contact your current employer?
Yes
No

If no, please explain:
Please indicate any actual experience, special training, and qualifications that you have which you feel are relevant to the position for which you are applying:
Have you ever used another name?*
Yes
No
What name?*
Is there any additional information relative to a name change, use of an assumed name or nickname necessary to enable a check of your work and education record? If yes, please explain:
If hired, can you furnish proof that you are over 18 years of age?*
Yes
No
Are you capable of satisfactorily performing the essential job duties required of the position for which you are applying?*
Yes
No
Do you have adequate transportation to and from work?*
Yes
No

How many days of work have you missed in the last two years due to reasons other than paid holidays and vacation?
This past year: (# of days)
Year prior: (# of days)

High School
School Name*
Diploma Received?
Yes
Course of Study or Major
Grades Completed
9th Grade
10th Grade
11th Grade
12th Grade
Describe Specialized Training, Experience, Skills, and Extracurricular Activities
College / University
Did you attend a college or university?
Yes
School Name
Years Completed
1 Year
2 Years
3 Years
4 Years
5+ Years
Degree
Course of Study or Major
Describe Specialized Training, Experience, Skills, and Extracurricular Activities
Did you attend another college or university?
Yes
School Name
Years Completed
1 Year
2 Years
3 Years
4 Years
5+ Years
Degree
Course of Study or Major
Describe Specialized Training, Experience, Skills, and Extracurricular Activities
Graduate / Professional
Did you attend a graduate or professional school?
Yes
School Name
Years Completed
1 Year
2 Years
3 Years
4 Years
5+ Years
Degree
Course of Study or Major
Describe Specialized Training, Experience, Skills, and Extracurricular Activities
Trade or Correspondence
Did you attend a trade or correspondence school?
Yes
School Name
Years Completed
1 Year
2 Years
3 Years
4 Years
5+ Years
Degree
Course of Study or Major
Describe Specialized Training, Experience, Skills, and Extracurricular Activities
Other
Any other education?
Yes
School Name
Years Completed
1 Year
2 Years
3 Years
4 Years
5+ Years
Degree
Course of Study or Major
Describe Specialized Training, Experience, Skills, and Extracurricular Activities

Personal References
Please list persons who know you well – Not previous employers or relatives

Name*
Phone*
Relation*
Occupation*
Number of Years Known*

Name
Phone
Relation
Occupation
Number of Years Known

Name
Phone
Relation
Occupation
Number of Years Known
Field positions require you to lift a minimum of 170 lbs.

Is there any reason you might not be physically capable of performing this job?*
Yes
No
N/A

If yes, please explain:
Please upload your resume, cover letter, and each of the applicable credentials for the position you are applying for below. You can upload files saved as pdf, jpg, png, gif, tiff, doc, docx.
Resume and/or Cover Letter
Drop files here or Select files
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 4 MB, Max. files: 2.
California Driver's License or California ID
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 4 MB.
High School Diploma, GED, or California Certificate of Proficiency
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
EMS State License or Certification Card
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT, Paramedic, RN or RT)
American Heart Association BLS for Healthcare Provider CPR/AED Certification Card (or printout)
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT, Paramedic, RN, or RT)
FMCSA Medical Examiner's Certificate (MEC), Form MCSA-5876
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
California Ambulance Driver Certificate (DMV DL 61)
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT or Paramedic)
DMV K-4 Driver Record Report
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
FEMA Incident Command System ICS 100 or IS-100 Course Completion Certificate
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT or Paramedic)
FEMA Incident Command System ICS 200 or IS 200 Course Completion Certificate
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT or Paramedic)
FEMA NIMS IS-700 Course Completion Certificate
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT or Paramedic)
FEMA National Response IS-800 Course Completion Certificate
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT or Paramedic)
FEMA Introduction to Hazardous Materials IS-5 Course Completion Certificate
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT or Paramedic)
FEMA Hazardous Materials Awareness AWR-358 DL Course Completion Certificate
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 2 MB.
(Applicable for EMT or Paramedic)
Other Applicable Certifications or Licenses
Drop files here or Select files
Accepted file types: pdf, jpg, png, gif, tiff, doc, docx, Max. file size: 4 MB, Max. files: 5.

Please indicate three days and times below, that best work for you for an interview appointment.
Day of the Week (First Choice)
Indicate your First Choice weekday.
Time Range (First Choice)
Indicate your available time range between 9 am – 5 pm.
Day of Week (Second Choice)
Indicate your Second Choice weekday.
Time Range (Second Choice)
Indicate your available time range between 9 am – 5 pm.
Day of Week (Third Choice)
Indicate your Third Choice weekday.
Time Range (Third Choice)
Indicate your available time range between 9 am – 5 pm.

APPLICANT’S STATEMENT & AGREEMENT
In the event of my employment in a position in this company, I will comply with all rules and regulations of this company. I understand that the company reserves the right to require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment, to the extent permitted by law. I also understand that any offer of employment may be contingent upon the passing of a physical examination and drug test. I consent to the disclosure of the results of any physical examination and related tests to the company. I also understand that I may be required to take other tests such as personality and honesty tests, prior to and during my employment. I understand that should I decline to sign this consent or take any of the above tests, my application for employment may be rejected or my employment may be terminated. I understand that bonding may be a condition of hire. If it is, I will be so advised either before or after hiring and a bond application will have to be completed.

I further understand that the company may obtain Public Records about me as part of an internal background investigation.

I further understand that the Company may contact my previous employers. I authorize those employers to disclose to the Company all records and information pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I hereby wave any rights or claims I have or may have against my former employers, their agents, employees, and representatives, as well as other individuals who release information to the company and release them from any person or party, whether such information is favorable or unfavorable to me. I authorize the persons named herein as personal references to provide the company with any pertinent information they may have regarding me.

I hereby state that all the information that I have provided on this application or any other documents completed in connection with my employment, and in any interview is true and accurate. I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that if I am employed and any information provided to the company is found to be false or incomplete in any respect that my employment may be terminated.

If hired, I agree as follows: My employment and compensation is terminable at-will, is for no definite period, and my employment and compensation may be terminated by either the company (employer) or me at any time and for any reason whatsoever, with or without good cause.

In consideration of my employment by AMBUSERVE, INC. or one of its affiliates, subsidiaries, related entities, or parent companies (collectively, “the Company”) and the mutual covenants in this Agreement, the Company and I agree that this Dispute Resolution Agreement (this “Agreement”) will apply to all covered legal claims between the Company and me. This Agreement is an arbitration agreement governed by the Federal Arbitration Act, 9 U.S.C. sections 1 et seq., and evidences a transaction involving commerce. En relación con mi empleo en AMBUSERVE, INC. o una de sus filiales, subsidiarias, entidades relacionadas o empresas matrices (en adelante, “la Compañía”) y las cláusulas de este Acuerdo, la Compañía y yo acordamos que este Acuerdo de Resolución de Disputas (en adelante, “Acuerdo”) regirá todas las reclamaciones legales que pudieran surgir entre la Empresa y quien suscribe. Este Acuerdo es un acuerdo de arbitraje en conformidad con la Ley Federal de Arbitraje, 9 U.S.C. secciones 1 y posteriores, y tiene por objeto regular una transacción de naturaleza comercial. 1. Covered Claims. Except as otherwise provided in this Agreement, the Company and I mutually agree that pursuant to the Federal Arbitration Act all disputes arising out of, or related directly or indirectly to, my employment relationship with, or the termination of my employment from, the Company and/or any putative joint or client employer (including but not limited to a client employer that retains labor from the Company) shall be resolved only by an Arbitrator through final and binding arbitration and not by way of court or jury trial. This includes, without limitation, disputes concerning any or all of the following: wage and hour law(s) (federal, state and local), trade secrets, unfair competition, compensation, breaks and rest periods, uniform maintenance, training, termination, discrimination, harassment, and claims arising under state and federal statutes and/or common law addressing the same or similar subject matters. This Agreement does not apply to claims for workers compensation, state disability insurance, unemployment insurance benefits, or any other subject matter precluded by law. This Agreement does not apply where applicable law permits access to an administrative agency, such as, for example, the Equal Employment Opportunity Commission or the National Labor Relations Board, despite the existence of an agreement to arbitrate. This Agreement does not prevent or excuse a party from bringing an administrative claim before any agency where the party is obliged to exhaust administrative remedies before making a claim in arbitration. The Company and I mutually agree that any disputes relating to the interpretation or application of this Agreement shall be resolved by the Arbitrator, but that any disputes over the enforceability, revocability, or validity of this Agreement, or any portion of it, will be decided by a court and not by the Arbitrator. Nothing contained in this Agreement shall be construed to prevent or excuse me from utilizing the Company’s internal complaint procedures. Reclamaciones contempladas. A menos que en este acuerdo se establezca lo contrario, la Compañía y quien suscribe acuerdan que, conforme con la Ley Federal de Arbitraje, todas las disputas que surgieran, directa o indirectamente relacionadas con mi relación laboral o la extinción de dicha relación con la Compañía o y/o cualquier empleador conjunto o cliente putativo (incluyendo, pero sin limitarse a, un empleador cliente que retenga mano de obra de la Compañía) serán resueltas únicamente por un árbitro a través de un arbitraje final y vinculante y no por medio de un tribunal o un juicio con jurado. Esto incluye, sin limitación, las disputas relativas a cualquiera o todas las siguientes: leyes sobre salarios y horas (federales, estatales y locales), secretos comerciales, competencia desleal, compensación, pausas y períodos de descanso, mantenimiento de uniformes, formación, despido, discriminación, acoso, y reclamaciones que surjan en virtud de los estatutos estatales y federales y/o el derecho común que abordan los mismos temas o similares. El presente Acuerdo no se aplica a las reclamaciones de indemnización de los trabajadores, al seguro de incapacidad estatal, a las prestaciones del seguro de desempleo u otras excluidas por la ley. Este Acuerdo no rige cuando la legislación aplicable permite el acceso a una agencia administrativa, como, por ejemplo, la Comisión de Igualdad de Oportunidades en el Empleo [Equal Employment Opportunity Commission] o la Junta Nacional de Relaciones Laborales [National Labor Relations Board], a pesar de la existencia de un acuerdo de arbitraje. El presente Acuerdo no impide que cualquiera de las partes pueda presentar una reclamación administrativa ante cualquier organismo que obligue a agotar los recursos administrativos antes de presentar una demanda de arbitraje. La Compañía y quien suscribe acuerdan que toda disputa relacionada con la interpretación o aplicación de este Acuerdo será resuelta por el Árbitro, pero que las disputas sobre la aplicabilidad, revocabilidad o validez de este Acuerdo, o cualquier parte de este, se resolverán ante a un tribunal y no ante el Árbitro. Este Acuerdo de ningún modo impide a quien suscribe utilizar los procedimientos internos de la Compañía para elevar reclamaciones. 2. Selecting the Arbitrator. The Arbitrator shall be selected by mutual agreement of the Company and me. Unless the Company and I mutually agree otherwise, the Arbitrator shall be an attorney licensed to practice in the state where the arbitration proceeding will be conducted or a retired federal or state judicial officer who presided in the jurisdiction where the arbitration will be conducted. If for any reason the parties cannot agree to an Arbitrator, either party may apply to a court of competent jurisdiction, with authority over the location where the arbitration will be conducted, for appointment of a neutral Arbitrator. The location of the arbitration proceeding shall be no more than 50 miles from the place where I last worked for the Company, unless each party to the arbitration otherwise agrees in writing. Elección del Árbitro. El Árbitro se elegirá con el consenso de ambas partes. Excepto que la Compañía y quien suscribe acuerden lo contrario, el Árbitro deberá ser un abogado con licencia para actuar en el estado donde se lleve a cabo el procedimiento de arbitraje o un juez federal o estatal retirado que haya presidido en la jurisdicción donde se llevará a cabo el arbitraje. Si por algún motivo las partes no pudieran llegar a un acuerdo para elegir un Árbitro, podrán solicitar a un juez competente, con jurisdicción en el lugar donde se llevará a cabo el arbitraje, que designe un Árbitro neutral. El lugar donde del arbitraje deberá estar a no más de 50 millas del último lugar donde trabajé para la Compañía, excepto que ambas partes expresen lo contrario por escrito. 3. Starting the Arbitration Process. To demand arbitration, either the Company or I must deliver a written demand by hand or first-class mail to the other party within the applicable statute of limitations period. The demand for arbitration shall include identification of the parties, a statement of the legal and factual basis of the claim(s), and a specification of the remedy sought. (In cases where the plaintiff first files a complaint in court instead of a written demand to arbitrate, the responding party’s written demand for arbitration need not include a statement as to the basis of the plaintiff’s claims(s) or the remedy sought.) Any demand for arbitration made to the Company shall be provided to the Company’s Management at hr@ambuserve.net. Any demand for arbitration made to me shall be mailed to my last known address. The Arbitrator shall resolve all disputes regarding the timeliness or propriety of the demand for arbitration. Inicio del proceso de arbitraje. Para iniciar un proceso de arbitraje, la Compañía o quien suscribe deben enviar a la otra parte una notificación escrita a mano o mediante correo first-class dentro del período contemplado en la legislación. La solicitud de arbitraje debe incluir información sobre las partes, un resumen de los hechos que motivan la reclamación y el detalle de la compensación esperada. (En los casos en los que el demandante presente primero una demanda judicial en lugar de una demanda de arbitraje por escrito, la parte demandada no deberá incluir los hechos que motivan la demanda ni la compensación buscada). Toda demanda de arbitraje dirigida a la compañía debe enviarse a los Directores de la Compañía por correo electrónico a hr@ambuserve.net. Toda demanda de arbitraje dirigida a quien suscribe debe ser notificada a mi última dirección declarada. El Árbitro resolverá toda disputa relacionada con las formas y el contenido de la demanda de arbitraje. 4. How Arbitration is Conducted. During arbitration, the parties will have the right to file pleadings, subpoena witnesses, bring dispositive motions, and present witnesses and evidence as needed to support their claims and defenses. The parties will also have the right to conduct adequate discovery to ensure that each party has access to all essential witnesses, facts, and documents. Any disputes with respect to the preceding items shall be resolved by the Arbitrator. Procedimiento del Arbitraje. Durante el proceso de arbitraje, las partes tendrán derecho a presentar escritos, testigos, mociones y todo tipo de evidencia que respalde su reclamación y argumentos. Las partes también tendrán derecho a un período de producción de prueba para garantizar que ambas partes tengan acceso a todos los testigos, hechos y documentos. Toda controversia relacionada con lo anterior deberá ser resuelta por el Árbitro. 5. Paying for the Arbitration. Each party will pay the fee for his, her or its own attorneys, subject to any remedies to which that party may later be entitled under applicable law. However, the Company will pay the Arbitrator’s arbitration fees and costs. Costas del Arbitraje. Cada una de las partes deberá asumir los gastos de honorarios de sus abogados, sin perjuicio de las compensaciones que puedan corresponderles más adelante según la legislación aplicable. Sin embargo, la Compañía asumirá los costos del arbitraje y los honorarios del Árbitro. 6. The Arbitration Hearing and Award. The parties will arbitrate their dispute before the Arbitrator, who shall confer with the parties regarding the conduct of the hearing and resolve any disputes the parties may have in that regard. Within 30 days of the close of the arbitration hearing, any party will have the right to prepare a brief which it must serve on the other party and file with the Arbitrator. The Arbitrator may award any party any remedy to which that party is entitled under applicable law, but such remedies shall be limited to those that would be available to a party in his or her individual capacity in a court of law for the claims presented to and decided by the Arbitrator. This Agreement is not intended to cause the forfeiture of any remedy that can be awarded exclusively by a court of competent jurisdiction. The Arbitrator will issue a decision or award in writing, stating the essential findings of fact and conclusions of law. Except as may be permitted or required by law, as determined by the Arbitrator, neither a party nor an Arbitrator may disclose the existence, content, or results of any arbitration hereunder without the prior written consent of all parties. A court of competent jurisdiction shall have the authority to enter a judgment upon the award made pursuant to the arbitration. Audiencia de arbitraje y laudo arbitral. Las partes resolverán todas las disputas ante el Árbitro, quien instruirá a las partes acerca del procedimiento y atenderá todas las controversias de esa índole. Dentro de los 30 días posteriores al cierre de la audiencia de arbitraje, las partes tienen derecho a presentar un escrito que deberán notificar a la otra parte y presentar ante el Árbitro. El Árbitro puede conceder la compensación que le corresponda a cualquiera de las partes según la legislación aplicable, pero dicha compensación se limitará a la que podría corresponderles a las partes en un proceso por vía judicial en relación con las reclamaciones presentadas sometidas a arbitraje. Este Acuerdo no excluye otras compensaciones que puedan corresponderle a las partes por vía judicial. El Árbitro emitirá un laudo por escrito que incluirá los principales argumentos y las conclusiones de hecho y derecho. A menos que la Ley así lo exija, ni las partes ni el Árbitro podrán develar la existencia ni el contenido del laudo arbitral sin previo consentimiento por escrito de las partes. Un juez competente podrá emitir una sentencia a partir del laudo arbitral. 7. Class Action Waiver. There will be no right or authority under this Agreement for any dispute to be brought, heard, or arbitrated as a class or collective action (“Class Action Waiver”). Notwithstanding any other clause contained in this Agreement, this Paragraph is not severable from this Agreement in any case in which the dispute to be arbitrated is brought as a class or collective action. Notwithstanding any other clause contained in this Agreement, any claim that the Class Action Waiver is unenforceable, unconscionable, void or voidable, must be determined by a court of competent jurisdiction and not by an Arbitrator. Renuncia a la acción de clase. Según este acuerdo, no podrán iniciarse acciones colectivas (“Renuncia a la acción de clase”). Sin perjuicio de otras cláusulas contenidas en este Acuerdo, este Párrafo no es separable del resto del Acuerdo en ningún caso si la disputa a resolver fuera presentada de manera colectiva. Sin perjuicio de otras cláusulas, la invalidez o nulidad de esta cláusula solo podrá ser determinada por un juez competente, y no por un árbitro. 8. PAGA Representative Action Waiver. The Company and I mutually agree that, pursuant to the Federal Arbitration Act, all disputes arising out of the California Private Attorneys General Act, or related directly or indirectly to any claims derived from the California Labor Code, shall be subject to binding arbitration under this Agreement on an individual basis only (“PAGA Representative Action Waiver”). The parties agree that in the event any PAGA claims are filed in civil court, my individual PAGA claims shall be resolved only by an Arbitrator on an individual basis through final and binding arbitration and not by way of court or jury trial. There shall be no right or authority for claims to be asserted in arbitration on behalf of other parties. Notwithstanding any other clause contained in this Agreement, any claim that the PAGA Representative Action Waiver is unenforceable, unconscionable, void or voidable, must be determined by a court of competent jurisdiction and not by an Arbitrator. Renuncia a la acción de clase PAGA. La Compañía y yo acordamos mutuamente que, de conformidad con la Ley Federal de Arbitraje, todas las disputas que surjan de la Ley del Procurador General Privado en California, o que estén relacionadas directa o indirectamente con cualquier reclamación derivada del Código Laboral de California, estarán sujetas a un arbitraje vinculante en virtud de este Acuerdo solo de forma individual (“Renuncia a la Acción de clase PAGA”). Las partes acuerdan que en el caso de que se presenten reclamaciones mediante PAGA en un tribunal civil, mis reclamaciones individuales serán resueltas únicamente por un árbitro de forma individual a través de un arbitraje final y vinculante y no por medio de un tribunal o un juicio con jurado. Las reclamaciones no podrán ser sometidas a arbitraje en nombre de terceros. Sin perjuicio de cualquier otra cláusula contenida en este Acuerdo, la invalidez o nulidad de esta Renuncia a la acción de clase PAGA solo podrá ser determinada por un juez competente, y no por un árbitro. 9. Enforcement of this Agreement. This Agreement is the full and complete agreement relating to the formal resolution of employment related disputes, and to the extent it becomes applicable, supersedes any existing agreement between the parties with regard to the arbitration. Except as provided in Paragraph 7, above, in the event any portion of this Agreement is deemed unenforceable, the remainder of this Agreement shall be enforceable. If Paragraph 7 or 8 is deemed to be unenforceable, the Company and I agree that this Agreement is otherwise silent as to any party’s ability to bring a class, collective, or representative action in arbitration. This Agreement shall survive the termination of my employment and the expiration of any benefit plan. If I am later re-employed by the Company, this Agreement will remain in full force and effect during any later employment and will survive the termination of any such later employment. Cumplimiento del Acuerdo. Este Acuerdo constituye la totalidad del acuerdo entre las partes en relación con la resolución de toda disputa relacionada con el empleo y, en la medida en que sea aplicable, sustituye cualquier otro instrumento existente entre las partes con respecto al arbitraje. Excepto por lo previsto en el Párrafo 7, si se determinara que una parte de este Acuerdo no es exigible, el resto conservará plena vigencia y validez. Si un juez determina la invalidez de los Párrafos 7 u 8, la Compañía y quien suscribe acuerdan que este Acuerdo no se pronuncia sobre el derecho de las partes a someter acciones colectivas a arbitraje. Este acuerdo no se extingue con el cese de la relación laboral ni la caducidad de ningún plan de beneficios. Si la Compañía vuelve a contratarme en un futuro, este Acuerdo conservará plena vigencia y continuará vigente aún después del cese de la nueva contratación. 10. No Retaliation for Exercising Rights Under this Agreement. It is against Company policy for me to be subject to retaliation if I exercise my right to assert claims under this Agreement. If I believe that I have been retaliated against by anyone at the Company, I understand that I should immediately report this to the Human Resources Department. I understand that I will not be retaliated against, disciplined or threatened with discipline as a result of my exercising my rights under Section 7 of the National Labor Relations Act. The Company reserves the right to lawfully seek enforcement of this Agreement and the Class Action Waiver and PAGA Representative Action Waiver under the Federal Arbitration Act and seek dismissal of any such class, collective or representative actions or claims subject to the Agreement and the Class Action Waiver and the PAGA Representative Action Waiver. No represalia por ejercer los derechos que confiere este Acuerdo. La Compañía se compromete a no tomar ningún tipo de represalia contra mi persona en el caso que decidiera hacer valer los derechos que este Acuerdo me confiere. En caso de sufrir algún tipo de represalia, comprendo que debo notificar de inmediato al Departamento de Recursos Humanos. Asimismo, comprendo que no recibiré sanciones ni sufriré represalias por ejercer los derechos que se me confieren según la Cláusula 7 de la Ley Nacional de Relaciones Laborales. La Compañía se reserva el derecho a exigir el cumplimiento de este Acuerdo, la Renuncia a la acción de clase y la Renuncia a la acción de clase PAGA en conformidad con la Ley Federal de Arbitraje y a accionar para que se desestime toda acción de clase según los términos de este Acuerdo, la cláusula de Renuncia a la acción de clase y la cláusula sobre las acciones mediante PAGA. I understand that I must arbitrate whatever individual claims I have against the Company and that by signing this Agreement I will be giving up the right to represent others in litigation or to participate in any class, collective, or representative action in a court of law. I further understand that I may consult with an attorney as to any aspect of this Agreement. This Agreement is the full and complete agreement relating to the formal resolution of disputes and to the extent it becomes applicable, supersedes any existing agreement between the parties with regard to arbitration. Me comprometo a someter a arbitraje toda reclamación contra la Compañía y comprendo que, con la firma de este Acuerdo, renuncio a representar a otros en la corte y participar de toda demanda de clase o colectiva ante un juez. Asimismo, comprendo que puedo consultar a un abogado en relación con cualquier parte de este Acuerdo. Este Acuerdo constituye la totalidad del acuerdo entre las partes y, en la medida en que sea aplicable, sustituye cualquier otro instrumento existente entre las partes con respecto al arbitraje. MY SIGNATURE INDICATES THAT I HAVE READ AND I UNDERSTAND ALL OF THE TERMS CONTAINED IN THIS DISPUTE RESOLUTION AGREEMENT. I UNDERSTAND THAT EMPLOYMENT AT THE COMPANY CONSTITUTES ACCEPTANCE OF THIS AGREEMENT AND ITS TERMS AND THAT THE COMPANY AND I ARE MUTUALLY BOUND BY ITS TERMS. CON MI FIRMA CERTIFICO QUE HE LEIDO Y COMPRENDIDO TODAS LAS CLÁUSULAS DE ESTE ACUERDO DE RESOLUCIÓN DE DISPUTAS. COMPRENDO QUE AL TRABAJAR EN LA COMPAÑÍA ACEPTO LOS TÉRMINOS DE ESTE ACUERDO Y QUE ESTE INSTRUMENTO ES VINCULANTE PARA AMBAS PARTES.

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I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.
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