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First Name
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Last Name
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Email
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Please enter email provided on original application.
Contract Accepted
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I Accept Contract / Hiring Letter of Intent
I Do Not Accept Contract / Hiring Letter of Intent
Please review and accept contract.
Policies Received and Accepted
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I Have Received and Agree to Abide
I Have Not Received
I Do Not Agree to Abide
I have received the CFAIA Employee Handbook - Personnel Policies and Procedures, as well as the Sexual Harrassment and Prohibited Discriminatory Practices and agree to abide by these policies.
Primary Contact
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In case of emergency, please use the following as my primary contact. Please list name, relationship and contact information.
Primary Contact Phone
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Primary Contact Relationship
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Spouse
Partner
Mother
Father
Sister
Brother
Son
Daughter
Friend
Other
Secondary Contact
In case of emergency, please use the following as my secondary contact. Please list name, relationship and contact information.
Secondary Contact Phone
Please put phone number of your secondary contact
Secondary Contact Relationship
Spouse
Partner
Mother
Father
Sister
Brother
Son
Daughter
Friend
Other
Please state relationship to secondary contact
Post Offer Medical Questionnaire
Employee Affirmation:
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I Affirm
I Do Not Affirm
I herewith affirm that the employer has made me an offer of employment, conditioned on the satisfactory completion of this questionnaire. The purpose of this inquiry is: to determine whether I currently have the physical qualifications necessary to perform the job that has been offered; to determine whether and what accommodations may be necessary; and to determine whether I can perform the essential functions of the job, without posing a significant direct threat to the health and safety of myself and others. This information will be kept strictly confidential. I hereby affirm that the questions in the medical questionnaire have not been asked of me by anyone with the employer until after I have signed this statement and been offered a conditional job.
Height
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Please type in your height in feet and inches.
Weight
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Please type in your weight.
Sex
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Male
Female
Do you now have, or have you ever had, and of the following?
Epilepsy (convulstions, seizures)
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Yes
No
Diabetes
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Yes
No
Cardiac disease
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Yes
No
Meniscectomy (inflamation of cartilage of certain joints - e.g., knee)
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Yes
No
Amputation of foot, leg, arm or hand
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Yes
No
Total loss of sight in one or both eyes, or a partial loss of corrected vision of more than 75% biaterally
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Yes
No
Polio (poliomyelitis)
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Yes
No
Cerebral palsy
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Yes
No
Multiple sclerosis
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Yes
No
Parkinson's disease
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Yes
No
Patellectomy (surgically removed kneecap)
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Yes
No
Ruptured cruciate ligament (knee ligament)
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Yes
No
Hemophilia
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Yes
No
Chronic osteomyelitis (infection in bone)
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Yes
No
Surgical or spontaneous fusion of a major weight-bearing joint (frozen joint)
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Yes
No
Hyperinsulinism
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Yes
No
Muscular dystrophy
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Yes
No
Thrombophlebitis
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Yes
No
Herniated intervertebral disk
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Yes
No
Surgical removal of an interverebral disk, or spinal fusion
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Yes
No
Total deafness
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Yes
No
One or more back or neck injuries, or a disease process of the back or neck, substantiated by a doctor's opinion and resulting in disability over a total of 120 or more days
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Yes
No
Obesity (30% overweight)
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Yes
No
Have you previously received workers' compensation for an on-the-job injury?
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Yes
No
If yes, when, why and where?
Have you ever received a disability rating or had one assigned to you by an insurance company or state/federal agency?
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Yes
No
If yes, whate percentage?
Have you ever injured or sprained your back?
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Yes
No
If yes, did you have surgery? If you had surgery please explain.
Have you ever injured or sprained your neck?
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Yes
No
Neck: If yes, did you have surgery? If you had surgery please explain.
Have you ever injured or sprained a knee?
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Yes
No
Knee: If yes, did you have surgery? If you had surgery please explain.
Have you ever had any other type of surgery not mentioned above?
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Yes
No
If yes, please explain:
Do you have arthritis?
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Yes
No
If yes, are you on medication? If yes, which parts of the body are affected:
In order for you to work in a safe and effective manner, please advise of any current physical limitations that need to be accommodated.
Please advise your manager of any work restrictions as soon as you become aware of this need.
The information on this form shall not be used to discriminate against a qualified individual with a disability in regard to the following: job application procedures; hiring, advancement or discharge of the employee.
Signature for Health Questionnaire
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I Declare
I Do Not Declare
Under penalty of perjury, I declare that I have read the foregoing and that the facts alleged are true to the best of my knowledge and belief.
Pet Liability Release Form
CFAIA employees, including campground and recreation area hosts, may be accompanied by a pet only when fulfilling those duties that allow the employee to provide full-time, hands-on restraint by an appropriate restraint system (e.g. leash, harness, etc.). With prior written approval by a CFAIA Director, Supervisor, or Manager, pets with special needs may be safely maintained in a pen or crate in a work environment on a case by case basis.
Will you be bringing a pet?
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Yes
No
If yes, then:
I Agree
I Do Not Agree
I warrant and represent that any pet is current on required shots and immunizations, and I agree to abide by recreation area/campground pet rules and local leash laws. I assume and bear all the risk of loss, injury and damage of any kind to my pet while at or on the recreation area or campground property, whether caused through my negligence, the actions of other guests or employees, or the actions of other pets or wild animals, and shall hold the CFAIA harmless for any such claims. I assume and shall bear all risk of loss, injury and damage of any kind or nature to any employee or property of the CFAIA and other recreation area/campground guests caused by my pet, and I agree to indemnify and defend the CFAIA and hold it harmless for any such claims.
Family/Guest Release Form
If you have Family/Guests staying with you, then:
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I Understand and Acknowledge
I Do Not Understand and Acknowledge
I understand and acknowledge that I am fully aware of and assume the risks, including but not limited to the risk of serious bodily injury, property loss or damage to family members or guests staying at my site during my contract term with the CFAIA, including days on site during pre-orientation, training, and post-contract transition. I understand that the CFAIA shall have no responsibility to pay for medical treatment and related costs if a family member or guest is injured. I understand that my family members and guests are expected to abide by CFAIA policies at all times.
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