Reinstatement Application Template
Posted: Wed May 04, 2022 9:57 pm
Any ex-employee (including P-EMT) must use the reinstatement form. This is valid for either resignations/terminations.
Name: FNAME LNAME
Date: DD/MM/YYYY
Rank Before Resignation:
Date of Employment:DD/MM/YYYY
Date of Resignation/Termination:DD/MM/YYYY
1. Did you resign, or were you terminated:
[ ] Terminated [ ] Resigned
2. Reason for resignation/termination:
2.1 If you resigned, was there an active IA report against you?
[ ] No [ ] Yes
3. Reason for applying again:
4.1 Why should you be rehired within LSEMS?
4.2 What divisions were you apart of prior to your discharge?
4.3 What can we expect from you if you are reinstated?
5. Have you been charged with any felonies since your discharge?
[ ] No [ ] Yes
5.1 If you selected yes to the previous question, please state the felonies/misdemeanors you have received and the reason.
6. What official types of employment did you have after your left MD? (E.g: DCC, PD, SD, DOC, GOV) (Copy and Paste if you had more than one)
- Name:
- Rank:
- Divisions and responsabilities (if any):
- Direct Supervisor:
Reinstatement | Fname Lname
Code: Select all
[divbox=#ffdead]
[img]https://imgur.com/YeNw9Dp.png[/img]
[divbox=white]
[b]Name:[/b] [i]FNAME LNAME[/i]
[b]Date:[/b] [i]DD/MM/YYYY[/i]
[b]Rank Before Resignation:[/b]
[b]Date of Employment:[/b][i]DD/MM/YYYY[/i]
[b]Date of Resignation/Termination:[/b][i]DD/MM/YYYY[/i]
[b]1. Did you resign, or were you terminated:[/b]
[ ] Terminated [ ] Resigned
[b]2. Reason for resignation/termination:[/b]
[b]2.1 If you resigned, was there an active IA report against you?[/b]
[ ] No [ ] Yes
[b]3. Reason for applying again:[/b]
[b]4.1 Why should you be rehired within LSEMS?[/b]
[b]4.2 What divisions were you apart of prior to your discharge?[/b]
[b]4.3 What can we expect from you if you are reinstated?[/b]
[b]5. Have you been charged with any felonies since your discharge?[/b]
[ ] No [ ] Yes
[b]5.1 If you selected yes to the previous question, please state the felonies/misdemeanors you have received and the reason.[/b]
[b]6. What official types of employment did you have after your left MD? (E.g: DCC, PD, SD, DOC, GOV)[/b] (Copy and Paste if you had more than one)
[list]
[*]Name:
[*]Rank:
[*]Divisions and responsabilities (if any):
[*]Direct Supervisor:
[/list]
[/divbox]
[img]https://i.imgur.com/oCDBSyA.png[/img]