YOUR PEOPLE PROFESSIONALS - INSTRUCTIONS FOR NEW APPLICANTS
Placement consideration for: CFL, Inc.
800-592-5906
(Fax) 805-346-7803
(Driver Positions Only)
Thank you for applying for employment with Your People Professionals. Please fill out this application in it's entirety.
Carefully and accurately complete the following sections. Please check of each section as you complete it.
Drivers Application for employment (read carefully, fill out completely, intial required
sections, sign and date
Pre-placement Controlled Substance & Alcohol Test Acknowledgement
Release of Alcohol and Drug Testing Records.
Applicant Statement and Agreement
DMV Printout (Original Copy, Not more than 30 days old) 10 year history H6
Commercial Drivers License (Attach Enlarged scan )
Long form Medical Card (Attach Enlarged scan )
Permanent Resident Card (If Applicable) (Attach Enlarged scan )
(1)I have filled out and printed the document in it's entirety and initialed all pages requesting initials and
intialed and signed the last page of this of this application. I will send to address or Fax :
CFL Inc.
P.O. Box 5668
Santa Maria, CA 93456
(Or )
Fax to: 805-346-7803
Or
(2) I have filled out the document to include my initials on all pages where requested and I have printed and
signed the last page of application and attached to e-mail that also has entire application attached. Please email to:
Driver Recruiting
I have read the Instructions for new applicant and have supplied your people professionals with all the information needed to process
the application.
NAME
INITIALS
HOME PHONE
DATE
CURRENT ADDRESS
CELL PHONE
CITY, STATE, ZIP
E-MAIL ADDRESS
DRIVER'S APPLICATION
FOR EMPLOYMENT
Applicant Name
Date
Company: CFL Inc. 800-592-5906
Fax 805-346-7803 E-mail: Driver.Recruiting.Email@cfl-usa.com
Address : P.O. Box 5668
City: Santa Maria
State: CA
Zip: 93456
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all
positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related
disability, or any other protected group status.
PLEASE READ AND INITIAL
I authorize you to such investigations and inquiries of my personal, employment, financial or medical history and other
related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical
history will be made only after a conditional offer of employment has been extended.) I herby release employers ,
schools, health care providers and other persons from all liability in responding to inquires and releasing information
in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s)
may result in discharge. I understand, also, I am required to abide by all rules and regulations of the company (CFL,
Inc. & YPP to include their agents and clients))
I understand that information I provide regarding current and/or previous employers may be used, and those
employer(s)will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR
391.23(D) and (E). I understand I have the right to;
1. Review information provided by my previous employer(s)
2. Have errors in the information corrected by previous employers and for those previous employers to re-send the
corrected information to the prospective employer.
3. Have a rebuttal statement attached to the erroneous information, if the previous employer(s) and I cannot agree
on the accuracy of the information.
Initial
Date
APPLICANT TO COMPLETE
(Answer all questions)
Position(s) Applied for
LAST NAME
FIRST NAME
MIDDLE
Social Security
List your address of residency for the last three years
Current Address
Street
City
Phon
e
How Long?
Cell
Phon
e:
Emergency Number
State
Zip Code
State
Zip Code
(Yr./ Mo.)
Previous Address (if less than three years at current address)
Street
City
Do you have the legal right to work in the United States
Date of Birth MM/DD/YYYY
(Required for all CDL applicants only)
Can you provide proof of age?
Have you worked for this company before?
Dates:
From:
Where?
To:
Rate of Pay:
Reason for leaving:
Are you now employed?
If not how long since your last employment?
Who referred you?
Rate of pay expected
Is there any reason you might be unable to perform the functions of the job for which you have applied as defined in the following job
description :
Includes vehicles having a GWVR of 26,001LBS. or more, vehicles designed to transport 15 or more passengers, or
any vehicle used to transport hazardous materials in a quantity requiring placarding.
The federal Motor Carrier Safety Regulations (FMCSR's) apply to anyone operating a motor vehicle on a highway in
interstate commerce to transport passengers or property when the vehicle : (1) weighs or has a GVWR of 10,001
pounds or more, (2) is designed or used to transport 9 or more passengers., OR (3) is of any size and is used to
transport hazardous materials in a quantity requiring placarding.
Can you perform the job listed above?
If you answered no please explain below
EMPLOYMENT HISTORY
All CDL applicants must provide the following information on all employes's during the preceding 3 years. List complete mailing
address, street number, city state zip.
CDL applicants shall also provide an additional 7 years of employment information regardless of the position held.
(NOTE: List Employers or employment gaps in reverse order starting with #1 the most recent. All gaps in employment need to be
noted.)
#1
Date:
MM/YY
to MM/YY
Are you currently employed ?
If no skip to #2
NAME
ADDRESS
POSITION HELD
CITY
STATE
CONTACT PERSON
ZIP
PHONE #
SALARY/WAGE
FAX#
REASON FOR LEAVING
WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLYED?
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE
DRUG AND ALCOHOLTESTING REQUIRMENTS OF 49 CFR PART 40?
#2
Date:
MM/YY
to MM/YY
Were you employed ?
If no skip to #3
NAME
ADDRESS
POSTION HELD
CITY
STATE
CONTACT PERSON
ZIP
SALARY/WAGE
PHONE#
FAX#
REASON FOR LEAVING
WERE YOU SUBJECT TO THE FMCRs WHILE EMPLOYED?
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE
DRUG AND ALCOHOLTESTING REQUIRMENTS OF 49 CFR PART 40?
#3
Date:
MM/YY
to MM/YY
Were you employed ?
If no skip to #4
NAME
ADDRESS
POSITION HELD
CITY
STATE
CONTACT PERSON
ZIP
PHONE#
SALARY / WAGE
FAX#
REASON FOR LEAVING
WERE YOU SUBJECT TO THE FMCRs WHILE EMPLOYED?
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE
DRUG AND ALCOHOLTESTING REQUIRMENTS OF 49 CFR PART 40?
#4
Date:
MM/YY
to MM/YY
Were you employed ?
If no skip to #5
NAME
ADRESS
POSITION HELD
CITY
CONTACT PERSON
STATE
ZIP
PHONE#
SALARY / WAGE
FAX#
REASON FOR LEAVING
WERE YOU SUBJECT TO THE FMCRs WHILE EMPLOYED?
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE
DRUG AND ALCOHOLTESTING REQUIRMENTS OF 49 CFR PART 40?
#5
DATE :
MM/YY
to MM/YY
Were you employed?
If no skip to #6
NAME
ADDRESS
POSITION HELD
CITY
STATE
ZIP
CONTACT PERSON
SALARY / WAGE
PHONE#
FAX#
REASON FOR LEAVING
WERE YOU SUBJECT TO THE FMCRs WHILE EMPLOYED?
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE
DRUG AND ALCOHOLTESTING REQUIRMENTS OF 49 CFR PART 40?
#6
DATE:
MM/YY
to MM/YY
Were you employed?
If no go to next section.
NAME
ADDRESS
POSITION HELD
CITY
STATE
ZIP
CONTACT PERSON
SALARY / WAGE
PHONE#
FAX#
REASON FOR LEAVING
WERE YOU SUBJECT TO THE FMCRs WHILE EMPLOYED?
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE
DRUG AND ALCOHOLTESTING REQUIRMENTS OF 49 CFR PART 40?
ACCIDENT RECORD FOR THE PAST THREE YEARS . IF NONE WRITE/TYPE NONE
DATES
NATURE OF ACCIDENT
(HEAD-ON, REAR-END, UPSET, ECT.)
FATALTIES
INJURIES
HAZMAT SPILL
LAST ACIDENT
NEXT PREVIOUS
NEXT PREVIOUS
TRAFFIC CONVICTIONS AND FORFETURES FOR THE PAST THREE YEARS (OTHER THAN PARKING VIOLATIONS)IF NONE
WRITE NONE
LOCATION
DATE
CHARGE
PENALTY
LOCATION
DATE
CHARGE
PENALTY
LOCATION
DATE
CHARGE
PENALTY
EXPERIENCE AND QUALIFCATIONS - DRIVER
LIST DRIVER LICENSE(S) BELOW
STATE
LICENSE NO.
TYPE
EXPIRATION DATE
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
B. Has any license ,permit or privilege ever been suspended or revoked?
IF THE ANSWER TO EITHER A OR B IS YES, GIVE DETAILS IN BOX BELOW
DRIVING EXPERIENCE SELECT YES OR NO SELECT TYPE
CLASS OF EQUIPMENT
EXPERIENCE (Jan 2012 = 01/12)
CHECK ALL EQUIPMENT TYPE THAT APPLIES
STRAIGHT TRUCK
VAN
REFR
TANK
FLAT
DUMP
MM/YY
MM/YY
TRACTOR TRAILER
VAN
REFR
TANK
FLAT
DUMP
MM/YY
MM/YY
TRACTOR TRAILOR
(Set Doubles)
VAN
REFR
TANK
FLAT
DUMP
MM/YY
MM/YY
MM/YY
MM/YY
MOTORCOACH SCHOOL BUS 15+
PASSENGERS
STATES OPERATED IN FOR THE LAST FIVE YEARS:
WA
OR
CA
NV
AZ
ID
SHOW ANY SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER:
WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?
EXPERIENCE AND QUILIFICATIONS - OTHER
SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK AT YPP
LIST COURSES AND TRAINING OTHER THAN SHOWN ELSE WHERE IN THIS APPLICATION
CERTIFICATES
TWIC
HAZMAT
EDUCATION
SELECT THE HIGHEST GRADE COMPLETED
LAST SCHOOL ATTENDED
INITI
ALS:
(NAME)
DATE
HIGH
SCHOOL
COLLEGE
(CITY, STATE)
UT
PART 1 - DOT DRUG AND ALCOHOL RELEASE
Employer: YPP / CFL, INC.
I authorize, per 49 CFR Part 40, the release of information from my DOT regulated drug and alcohol testing records
by the carriers (company / school) listed below to USIS for the sole purpose of transmitting such records to the above
listed employer. I authorize release of the following information concerning DOT drug and alcohol testing violations.
including pre-employment test during the last (3) years: (i) alcohol test with a result of 0.04 or higher; (ii) verified
positive drug test; (iii ) refusals to be tested(including verified adulterated or substituted results); (iv) other violations
of the DOT drug and alcohol testing regulations; (v) information obtained from your previous employers of a drug and
alcohol rule violation (s) ; and(vi) documents, if any, of completion of a return-to-duty process following a rule violation,
The information that I have authorized USIS to review involves test required by DOT. If any carrier (company or
school) listed below furnishes USIS with information concerning item (i) through (vi) above, I also authorize that
carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol test and/or test with
results below 0.04 during the three(3) year period and the name and phone number of any substance abuse
professional who evaluated me during the past three (3) years.
Company
City
State
Phone number (Format 555 - 555 -5555)
(Attach additional forms for additional past employers. Attached documents must also include the the individuals signature)
Print Applicant Name
Applicant Initials
Social Security No:
Date:
PART II - INVESTIGATIVE CONSUMER REPORT RELEASE
Pursuant to the Consumer Report Disclosure previously delivered to me , I authorize USIS Commercial Services to
prepare a consumer report or investigative consumer report about me for employment-related purposes. I have been
provided the summary of rights of the consumer pursuant to the Fair Credit Reporting Act (FCRA). I hereby fully
release and discharge USIS, their respective affiliates, subsidiaries, directors, officers,employees, agents and
attorneys thereof, and each of them, and any individual, organization,entity, agency, or other source providing
information to USIS from all claims and damages arising out of or relating to any investigation of my background for
employment purposes. This release is valid for all federal,state, county and local agencies ,authorities, previous
employers, military services and educational institutions.
USIS is authorized to disclose all information obtained. to the requesting entity for the purposes of making a
determination as to my eligibility for employment, promotion or any lawful purpose. I agree that such information USIS
has or obtains, and my employment history if I am hired, may be supplied by USIS to other companies that subscribe
to USIS. If hired or contracted., this authorization shall remain on file and serve as an ongoing authorization for the
procurement of consumer reports at any time during my employment or contract period.
THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATIONS OBTAINED UNDER PART I
By signing below, I certify that I have read and fully understand this release, that prior to signing I was given the opportunity to ask
questions and to have those question answered to my satisfaction, and that I executed this release voluntarily and with the
knowledge that the information being released could affect me being hired, my employment, or my eligibility for promotion.
Print Applicant Name
Applicant Initials
For the purposes of gathering this information, I agree to supply the following information, Which may be required by law enforcement
agencies and other entities for positive identification purposes when checking records. It is confidential and will not be used for any
other purposes.
Print other last names you have used.
List States & Counties of Residence for the past:
3 years
State
City / County
From Year
To Year
State
City /County
From Year
To Year
State
City / County
From Year
To Year
CFL, INC.
JOB DESCRIPTION AND DUTIES
Welcome to CFL, Inc. We specialize in providing personal for transportation in intrastate and interstate commerce servicing the seven
western states . Our base of operation is in Santa Maria, California .
We are committed to being a premier carrier and sincerely hope that your commitment parallels ours. We look forward to a long and
profitable association with you.
To be selected as a driver for CFL, Inc. you must be able to:
Drive a tractor-trailer combination or a truck with capacity of at least 26,000 GVW, to transport and deliver goods. May
be required to use automated routing equipment.
Requires commercial (Class A) drivers' license
Indicate
Yes/No
If you can and agree to perform each job function below or supply documents listed.
The applicant must successfully complete the application packet including a work history for the
previous ten years as required by regulation.
The applicant must provide originals for copy of (1) commercial Drivers License (CDL), (2)
Current DOT Medical (Green card)(If applicable);
(3) Social Security Card ;(4) Current DMVR (Form H6) (No longer than 30 days old) From DMV
Office. EDD printouts are not acceptable.
The applicant must agree to and sign authorization for CFL, Inc. to secure information from
previous employers with regards to drug and alcohol screening programs as well as safety
performance, and driving experience.
The applicant must agree must agree to and sign authorization for CFL, Inc. to obtain motor
vehicle reports and consumer reports.
The applicant must be able to operate a 3-axle tractor in combination with a 48' , 50', 53' trailer to
as required. Have the ability to pre trip vehicles before driving them to ensure that mechanical,
safety, and emergency equipment is in good working order. Perform post-trip maintenance
inspections including monitoring of liquid levels, tire pressure, refrigeration control, and make
minor repairs and/or adjustments as determined by safe operating practices.
The applicant must be available to work all available shifts on any day of the week where they
are in compliance with Federal Motor Carrier Safety Administration (FMCSA) Hours of Operation
(HOS) regulations.
The applicant must be able to communicate in english language as required by FMCSA
regulations in written or oral form.
The applicant must demonstrate the ability to use multiple communication devices including but not limited to
computers, tablets, telephone (cellular and land), and satellite (Omnitracs) as required.
The applicant must have ability to remove install and remove special equipment including tire
chains when required.
The applicant must show ability to properly load a 48', 50' and 53' trailer where it is safe and
properly distributed for weight.
The applicant must show ability to properly complete CFL, Inc. paperwork including but not
limited to,driver's inspections reports, freight bills and bills of lading.
Applicant must be able to follow special procedures related to specific cargo, including operation
of refrigeration systems when carrying frozen, chilled or fresh produce. (i.e start unit and set for
proper temperature, use of bulkheads, etc. )
Applicant must have sufficient physical strength to unload any product that we may haul (lifting 1
to 75 pounds). Must demonstrate ability and knowledge of forklift, electronic and manuel pallet
jacks.
Applicant must have the ability to crank to crank trailer landing gear up and down to safely
secure vehicles.
Secure cargo for transport, using load locks.
Remove any debris from trailers before loading and after unloading is complete.
General Notes:
Act as a representative for the company in the partnership between the company and the customers in meeting the transportation
needs of the customer in a timely, dependable, and safe manner.
I have read and understand the job description and duties for consideration of a driving position with CFL, Inc.
Print Name
Date
Initials
DRIVER PROFILE
Restrictions on traveling over county or state lines?
Restrictions to access or delivering to local, state, or federal prisons ?
Smoker
Pet (s)
Have you driven in snow
Have you installed tire chains?
Have you hauled produce Before
Are you you aware of temperature requirements of produce
Do you have refrigerated experience Frozen / Chill
How many years / months of verified experience
Have you performed multiple:
Have you used a temperature probe
Years
Pick-ups
Months
Drops
Have you delivered to chain stores and D.C. (check all that apply)
Vons
Safeway
Costco
Walmart
Do you know how to axle out to "Scale the load"
How many days out before you expect home time within reason:
Number of weeks:
Number of days:
Have you ever used Omnitracs Satellite Communications System?
What type of tractor have you driven
Transmissions are you familiar with
Cab-over
Automatic
Conventional
Automated
Others not listed
Print Name
Initials
9-Speed
10-Speed
13- Speed
SUMMARY OF RIGHTS UNDER THE FAIR CREDIT REPORTING ACT
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of
consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and
specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental
history records). Here is a summary of your major rights under the FCRA. For more information, including information
about additional rights, go to www.ftcgov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade
Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
? You must be told if information in your file has been used against you. Anyone who uses a credit report or another
type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse
action against you – must tell you, and must give you the name, address, and phone number of the agency that
provided the information.
? You have the right to know what is in your file. You may request and obtain all the information about you in the files of
a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may
include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure
if:
• a person has taken adverse action against you because of information in your credit report;
• you are the victim of identity theft and place a fraud alert in your file;
• your file contains inaccurate information as a result of fraud;
• you are on public assistance;
• you are unemployed but expect to apply for employment within 60 days.
In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from
each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for
additional information.
▪ You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on
information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or
distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions,
you will receive credit score information for free from the mortgage lender.
▪ You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is
incomplete or inaccurate, and report it to the consumer-reporting agency, the agency must investigate unless your
dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.
▪ Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate,
incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer
agency may continue to report information it has verified as accurate.
▪Consumer reporting agencies may not report outdated negative information. In most cases, a consumer-reporting
agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10
years old.
▪ Access to your file is limited. A consumer-reporting agency may provide information about you only to people with a
valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA
specifies those with a valid need for access.
▪ You must give your consent for reports to be provided to employers. A consumer-reporting agency may not give out
information about you to your employer, or a potential employer, without your written consent given to the employer.
Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit.
▪ You may limit “prescreened” offers of credit and insurance you get based on information in your credit report.
Unsolicited “pre-screened” offers for credit and insurance must include a toll-free phone number you can call if you
choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide
credit bureaus at 1-888-5-OPTOUT.
▪ You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports
or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or
federal court.
▪ Identity theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.gov/
credit.
▪ States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may
have more rights under state law. For more information, contact your state or local consumer protection agency or your
state Attorney General. Federal enforcers are:
APPLICANT STATEMENT AND AGREEMENT
I hereby state that all the information that I have provided on this application or on any documents completed in
connection with my employment, and in any interview is true and accurate. I have withheld nothing that would, if
disclosed, affect this application unfavorably. I understand that if I am employed and any information provided to Your
People Professionals (“YPP”) and/or CFL, Inc. (“CFL”) is found to be false or incomplete in any respect, I may be
dismissed. I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of
my identity and legal authority to work in the United States, and that federal immigration laws require me to complete
an I-9 form in this regard.
I also am declaring at this time that I do not currently have any restriction(s) that would bar me from traveling
over State lines or restrict me from delivering to Federal, State or Prisons.
I further understand that YPP and CFL may contact my previous employers. I authorize those employers to disclose
to YPP and CFL all records and information pertinent to my employment with them. Except with respect to
Department Of Transportation mandated alcohol and controlled substances testing, I hereby waive any rights or
claims I have or may have against my former employers, their agents, employees, and representatives, as well as
other individuals who release information to YPP and CFL, and release them from and all liability, claims, or damages
that may directly or indirectly result from the use, disclosure, or release of any such information by any person or
party, whether such information is favorable or unfavorable to me.
I understand that CFL will provide workers’ compensation insurance coverage for its employees. In the event of an
injury in workplace, I agree that my sole remedy lies in coverage under CFL’s workers’ compensation insurance
policy.
I further understand that my employment can be terminated, with or without cause or notice, at any time, at the
discretion of YPP, CFL or myself. I further understand that no manager or representative of YPP or CFL other than
the president of YPP has any authority to enter into any agreement, oral or written, on behalf of YPP for any specific
terms, of employment or to make any assurance or promise continued employment.
I understand that YPP and CFL may obtain a consumer and/or investigative consumer report for employment purpose
that may include information as to my character, general reputation, personal characteristics, and mode of living, work
experience and performance, along with reasons for the termination of past employment. The report may also contain
records check of driving, criminal, credit, education, degrees, professional licenses and/or certification records
depending on the position. By signing this statement, I authorize the procurement of a consumer and/or investigative
consumer report by YPP and CFL as part of the pre-employment background investigation and if hired, at any time
during my employment. I further understand that YPP and CFL may obtain Public Records about me as part of an
internal background investigation and that I may waive my right to receive a copy of such Public Records by selecting
yes or no below.
I waive my right to receive a copy of such Public Records noted above
I further agree and acknowledge that YPP, CFL and I will utilize binding arbitration to resolve all disputes that may
arise out of the employment context. YPP, CFL and I agree that any claim, dispute, and/or controversy that either I
may have against YPP and/or CFL (or their owners, directors, officers, managers, employees, agents, and parties
affiliated with their employee benefit and health plans) or that YPP and/or CFL may have against me, arising from,
related to, or having any relationship or connection whatsoever with my seeking employment with, employment by, or
other association with YPP or CFL shall be submitted to and determined exclusively by binding arbitration under the
Federal Arbitration Act, in conformity with the procedures of the California Arbitration Act (Cal. Code Civ. Proc. Sec
1280 et seq., including section 1283.05 and all of the Act’s other mandatory and permissive rights to discovery).
Included within the scope of this Agreement are all disputes, whether based on tort, contract, statute (including, but
not limited to, any claims of discrimination and harassment, whether they be based on the California Fair Employment
and Housing Act, Title VII of the Civil Rights Act of 1964, as amended, or any other state or federal law or regulation),
equitable law, or otherwise, with exception of claims arising under the National Labor Relations Act which are brought
before the National Labor Relations Board, claims for medical and disability benefits under the California Workers’
Compensation Act, Employment Development Department Claims, or as otherwise required by state or federal law.
However, nothing herein shall prevent me from filing and pursuing proceedings before the California Department of
Fair Employment and Housing, or the United States Equal Employment Opportunity Commission (although if I choose
to pursue a claim following the exhaustion of such administrative remedies, that claim would be subject to the
provisions of this Agreement). In addition to any other requirements imposed by law, the arbitrator selected shall be a
retired California Superior Court Judge, or otherwise qualified individual to whom the parties mutually agree, and shall
be subject to disqualification on the same grounds as would apply to a judge of such court. All rules of pleading
(including the right of demurrer), all rules of resolution of the dispute by means of motions for summary judgment,
judgment on the pleadings, and judgment under Code of Civil Procedure Section 631.8 shall apply and be observed.
Resolution of the dispute shall be based solely upon the law governing the claims and defenses pleaded, and the
arbitrator may not invoke any basis ( including but not limited to, notions of “just cause”) other than such controlling
law. The arbitrator shall have the immunity of a judicial officer from civil liability when acting in the capacity of an
arbitrator, which immunity supplements any other existing immunity, Likewise, all communications during or in
connection with the arbitration proceedings are privileged in accordance with Cal. Civil Code Section 47(b). As
reasonably required to all full use and benefit of this agreement's modifications to the Act's procedures, the arbitrator
shall extend the times set by the Act for the giving of notices and setting of hearings. Awards shall include the
arbitrator's written reasoned opinion. I understand and agree to this binding arbitration provision, and that I,
YPP and CFL give up our right to trial by jury of any claim I may have against YPP and CFL or that YPP and
CFL may have against me.
This is the entire agreement between YPP, CFL and me regarding dispute resolution, the length of my employment,
and the reasons for termination of employment, and this agreement supersedes any and all prior agreements
regarding these issues. It is further agreed and understood that any agreement contrary to the foregoing must be
entered into, in writing, by the President of YPP. No supervisor or representative of YPP, other than its President, has
any authority to enter into any agreement for employment for any specified period of time or make any agreement
contrary to the foregoing. Oral representations made before or after you are hired do not alter this Agreement.
If any term or provision, or portion of this Agreement is declared void unenforceable it shall be severed and the
remainder of this Agreement shall be enforceable.
IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A COMPANY
REPRESENTATIVE BEFORE SIGNING. I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE
STATEMENTS AND UNDERSTAND THE SAME.
DO NOT SIGN UNTIL YOU HAVE READE THE ABOVE STATEMENT & AGREEMENT
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REV: 8/2/2014 1624
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