Employment Application

Qualified applicants are considered for all positions. CAA is an equal opportunity employer and a drug-free workplace. All applicable questions must be answered.

Date *

Name *

First

Last

Desired Position *

In which program/department would you like to be considered for employment? *

Referral Source

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How long at this address?

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

When is the best time of day to call?

Email Address *

What date are you available for employment? *

What type of employment are you looking for?

Full time
Part time
Temporary
Seasonal

Are you able to work overtime if required?

Yes
No

Have you previously applied for a position at CAA?

Yes
No

When? Please explain.

Are you eligible to work in the United States? (Proof of eligibility will be required before you can be employed.) *

Yes
No

Are you presently on layoff and/or subject to recall from any other company?

Yes
No

If yes, explain:

Have you ever been convicted of/or pleaded guilty to a crime (other than minor traffic violations) in the past seven years? If yes, please explain (give date, location, charge, etc.)? *

If the job requires it, do you have a valid driver's license? Please list driver's license number, type, and state of issue. *

Have you had any moving violations in the last 3 years? If yes, please describe. *

Do you have any relatives currently employed by or on the Board of Directors of CAA? *

Yes
No

If yes, please list.

References

List names and telephone numbers of three (3) work references and at least two (2) personal references that are not related to you and are not previous supervisors. These references should have knowledge of your work ethic, experience, and abilities.

Business: *

Personal: *

Educational Background

High School: Please provide the name and city of your high school, number of years attended, and whether you graduated. *

College/University: If applicable, please provide the name and city of your college/university, number of years attended, whether you graduated, and your major and degree earned.

Post Graduate: If applicable, please provide the name and city of the college/university where you completed post graduate education, number of years attended, whether you graduated, and your major and degree earned.

Business or Trade: If applicable, please provide the business or trade school you attended, the number of years attended, whether you graduated, and the degree/certificate you earned.

Other: Please list any other relevant education.

Employment History

List your last three (3) employers, assignments or volunteer activities, starting with the most recent. Explain any gaps in employment in the comments section below.

Employer *

Phone *

Job Title *

Immediate Supervisor and Title *

Reason for Leaving *

May we contact for reference/verification? *

Yes
No
Later

Dates Employed (From mm/yy-To mm/yy) *

Hourly Rate/Salary (starting) *

Hourly Rate/Salary (final) *

Summarize the nature of the work performed and job responsibilities. *

Employer

Phone

Job Title

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference/verification?

Yes
No
Later

Dates Employed (From mm/yy-To mm/yy)

Hourly Rate/Salary (starting)

Hourly Rate/Salary (final)

Summarize the nature of the work performed and job responsibilities.

Employer

Phone

Job Title

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference/verification?

Yes
No
Later

Dates Employed (From mm/yy-To mm/yy)

Hourly Rate/Salary (starting)

Hourly Rate/Salary (final)

Summarize the nature of the work.

Comments and other skills and qualifications (including explanation of any gaps in employment):

My typed name (first and last) below certifies that the facts contained in this application and/or interview(s) are true and complete. Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date. I understand that, if employed, my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without prior notice. No representative of CAA other than the owner(s) is authorized to make any assurances or promises of continued employment and any such assurances must be in writing signed by the owner(s). If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct of CAA. This application will remain on active file for 60 days. If I am hired within this period, this form will be transferred to my individual personnel file. If I am not hired or have not heard from this employer within 60 days, this application is not longer active and I will need to reapply for employment if I wish to be considered for a job with CAA. I give the employer and/or its agents, including consumer and credit reporting bureaus, the right to investigate any and all statements made in this application for the purpose of employment and retention of employment. This investigation may include, but not limited to, financial and credit reports, criminal conviction records, motor vehicle driving records and previous employment history. Further, I hereby release from liability and hold harmless this employer, its’ representatives, all persons and organizations/companies for furnishing such information. I agree to submit to a drug testing when an employment offer is presented, prior to regular hire, and during employment for random and/or post accident testing. Certain positions at the CAA require a Mantoux (TB) testing. I agree to submit to the testing and reading of the test. If the Mantoux testing is done offsite I understand that it is my responsibility to ensure the results are faxed in to CAA health center designated personnel. The technology, equipment and methods make CAA (the Agency) unique. As used herein, "Confidential Information" means customer lists, lists of customers, advertising/marketing programs and strategies, new product concepts, ideas for enhancing existing products, pricing structures, personnel information, sales volume, computer programs, product names, product designs, cost information, past, present and future development processes, past, present and future capabilities and other proprietary information, whether retained in hard-copy form, computer disk or file, or any other medium. Such confidential information is valuable, special and unique to the Agency. Also considered confidential information is any password, passcode, ID number, keys and the like, for computer access or security for the building, as well as keys to the Agency's file cabinets, offices and desks. By signing below, you acknowledge that during the course of your employment with the CAA, you have had and will continue to have access to Confidential Information. You acknowledge that the Confidential Information is and always will be the property of the Agency, has been maintained as confidential information by the Agency, is highly valuable and proprietary to the Agency, and the disclosure of it to third parties or unauthorized use of it by the employee will cause the Agency serious competitive harm. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, provincial, or federal law. *

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References

Educational Background

Employment History

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