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  • EMPLOYMENT APPLICATION

  • Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application

    We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, sexual orientation, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.

    THE CHOCTAW COUNTY AMBULANCE AUTHORITY (CCAA) IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE TRUST OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

  • Applicant Information

  • Type of employment desired?Full-time□Part-time□(Specify Hours)

    Are you willing to work overtime?Yes□No

    Have you previously applied for employment with CCAA?Yes□No□

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  • EDUCATION

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  • Military Service

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  • References

    Please list three professional references.
  • Reference #2:

  • Reference #3

  • Previous Employment

  • I understand that CCAA may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the CCAA has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state and local law. I also understand that all employees, pursuant to CCAA policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests may be a condition of continual employment and I agree to undergo alcohol and drug testing consistent with CCAA policies and applicable federal, state, and local law.

    If employed by CCAA, I understand and agree that CCAA, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.

    I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement.

    I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

    CCAA IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, CCAA OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OR CCAA AUTHORIZED TO ENTER INTO AN AGREEEMENT – EXPRESS OR IMPLIED – WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGRESSMENT IS IN A WRITTEN CONTRACT SIGNED BY THE CONSOLIDATED DISPATCH DIRECTOR AND THE CCAA ADMINISTRATOR IF HRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF CCAA AND I UNDERSTAND THAT CCAA HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL.

    I authorize CCAA or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking to the extent permitted by federal, state and/or local law. If applicable and allowed by law, I will receive separate written notification regarding CCAA’s intent to obtain “consumer reports.”

    I authorize and consent to, without reservation, any party or agency contacted by CCAA to furnish the above- mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to CCAA or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability CCAA and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. Further, if hired, I authorize CCAA to provide truthful information concerning my employment to future employers and hold CCAA harmless for providing such information.

    If hired by CCAA, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by CCAA. I also understand CCAA employs only individuals who are legally eligible to work in the United States.

  • I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE,

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  • DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THE APPLICATION.

    2578 US 70 BYPASS, HUGO, OK 74743

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  • Background Check Authorization

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    The information contained in this application is correct to the best of my knowledge.

    I hereby authorize Choctaw County Ambulance Authority, (CCAA) and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from an criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

    I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to CCAA or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation or public agency may have, to include information or data received from other sources. CCAA and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and dates of birth.

    Please check the box below if you wish to receive a copy of a consumer report that is requested.

    I wish to receive a copy of any Background Check Report on me that is requested.

    2578 US 70 BYPASS, HUGO, OK 74743

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