Thank you for your interest in working at Lifestar! Please complete the application below.

All fields marked with a “*” are required.

Lifestar Emergency Medical Services, LLC is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status

Personal Information

Full Name*


Email Address*

How would you prefer to be contacted?*

TextEmailPhone Call

Street Address*

Street Address 2



Zip Code*

How did you hear about Lifestar?*

Are you legally authorized to work in the U.S.?*


(If hired, you will be required to provide proof of work authorization.)

Have you ever been convicted of a crime or pleaded no contest for any offense or violation other than minor traffic violations?*

(Convictions are not an automatic bar to employment.)


Have you ever applied at Lifestar before?*


If yes, when:

Have you ever worked at Lifestar before?*


If yes, when:

Position Information

Position Applying For:*

Full Time / Part Time:*

Salary Preference*

Location (check all that apply)*

East (West Bend, Slinger, Grafton)West (Columbus, Waupun)AdamsAny

EMS License Level:*

WI EMS License Number:

EMS License Expiration Date:

Please upload a resume showing all work history, education history, and certifications held.*

Files must be in pdf, doc, or docx format

Mac Pages documents must be converted to Word format before uploading

Affirmative Action Employer Voluntary Self-Identification Survey

Lifestar EMS is an Affirmative Action/Equal Employment Employer and as such, we are required to collect and maintain information related to applicants in order to meet governmental recordkeeping and reporting requirements and to monitor the effectiveness of our outreach, recruitment and other employment practices.

At this time, we are asking you to help us meet our obligations by providing the information listed on the following pages. Please note that the information will be used only in accordance with the provisions of applicable laws, executive orders, and regulations. Providing this information is voluntary and refusal to so will not result in any adverse treatment. The information you provide will be held in strict confidence except that:

  1. Necessary management and supervisory personnel may be informed to ensure proper placement and to provide reasonable job accommodations;
  2. First aid and safety personnel may be informed to the extent appropriate, if the condition might require emergency treatment; and
  3. Government officials investigating affirmative action program compliance may have access to reported information.

Thank you for your cooperation in this important initiative. Lifestar EMS abides by the requirements of federal laws which prohibit discrimination of individuals with the following legally protected status: race, color, religion, sex, sexual orientation, gender identity, national origin, disability and protected veterans. Lifestar EMS also abides by affirmative action requirements to employ and advance in employment qualified individuals without regard to race and sex (per Executive Order 11246), disability (per 41CFR 60-741.5(a),and protected veteran status (per 41CFR 60-300.5(a).

Affirmative Action Gender, Ethnicity, and Race Information
Affirmative Action Protected Veteran Status
Veteran Status Definitions
Disabled Veteran A “disabled veteran” is one of the following:

  • A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
  • A person who was discharged or released from active duty because of a service-connected disability.
Recently Separated Veteran A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
Active Duty Wartime or Campaign Badge Veteran An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Service Medal Veteran An “armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
I am a *:
If you are a disabled veteran, you may choose to use the space below to tell us about:
  1. Any special methods, skill, and procedures which qualify you for positions within Lifestar EMS so that you can be considered for any positions of that kind, and
  2. 2) We will make reasonable accommodations to qualified disabled veterans to ensure equal employment opportunity for all. If, because of your disability, you require a reasonable accommodation such as a change to application or work procedures, documents in an alternate format, sign language interpreter, or specialized equipment which would enable you to engage in the application process or perform the job properly and safely

By submitting this form, I agree to the following conditions:

  1. All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.
  2. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information about my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment.
  3. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified upon offer of employment.)
  4. Regardless of whether or not I become employed by the company, I recognize this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company’s, unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer or official of the company, and then only by means of a signed, written document.