Application for Employment

CTA Application for Employment Printable version here
Personal Information
First Name
Initial
Last Name
Present Address
Apt
City
State
Zip Code
Phone
Second Phone
Email Address
Are you 18 years or older? Yes No
Current Driver License Number Issuing State Expiration Date What is your means of transportation to work?
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? Yes No

Have you ever been convicted of a crime? Yes No If yes please explain:
Do you have any substantiated abuse claims against you from Adult Protective Services or Child Protective Services? Yes No
If yes, please explain:
(A criminal background and child abuse registry check is completed on all employees)
In the last five (5) years, have you lived in or spent six (6) or more consecutive weeks in a U.S. State besides Utah?
Yes No
If yes, which state?

In the last five (5) years, have you lived in or spent six (6) or more consecutive weeks in a foreign country or U.S. Territory?
Yes No
If yes, which country?

Person to notify in case of an emergency:
Name:
Address:
Phone:
Relationship:

Employment Desired

Which location are you applying for?

Employment desired

Full Time: Part Time:

Date you can start (mm/dd/yyyy)

How or from whom did you hear about the position?

The following are shifts/hours that may be required to work:

Overnight: 10:00 pm - 10:00 am
Weekends: 6:00 am-2:00 pm
2:00 pm - 10:00 pm
Morning: 6:00 am - 10:00 am
Afternoon: 2:00 pm - 10:00 pm
Holidays: All Hours

Days and hours available to work (estimate)		Sun	Mon	Tues	Wed	Thur	Fri	Sat
	From To

Previous Employment at CTA
Have you previously worked for CTA?	Yes No
If yes, when? (mm/dd/yyyy)	From: To:
Reason for Leaving

Education

	Name of School	Year Completed	Degree Earned	Major/Subject
High School
College
Other

References

Required: At least name and phone number for two people not related to you, whom you have known for at least one year.

Reference Name	Address	Phone No.	Occupation	Years Known

Former Employment

List below your last three employers, starting with the most recent.

Employer	Phone No.	Position/Duties	End Wage	Reason for Leaving	Dates of Employment

General
What is your experience with people who have autism and/or disabilities? (School, volunteer, work, family, friend) please describe:
Why are you interested in working with people with disabilities?
Do you have knowledge or experience with behavior management techniques? If so please describe:
Do you have experience with people who are non-verbal or have difficulty communicating? If so please describe:
Have you had any experience dealing with people who are aggressive? If so, please describe:
Have you had any experience helping people with personal care issues such as toileting, bathing, etc? If so, please describe:

CTA Application for Employment

Personal Information

Employment Desired

Previous Employment at CTA

Education

References

Former Employment

General