I, First Name   Last Name   certify that I do not have more than one motor vehicle license.     Signature   Date          
     

Previous Employer 1

Company Name    Area Code   Phone Number    Address:   Street Address   Address Line 2   City   State   Zip    
E-mail address:
Position Held:        
Reason For Leaving:         
Start Date     End Date   

Were you subject to the FMCSRs while employed by the previous employer?
Yes   No   

Was the previous job position a safety sensitive function in any DOT regulated mode, subject to alcohol and drug testing requirements?
Yes   No   

Previous Employer 2

Company Name    Area Code   Phone Number    Address:   Street Address   Address Line 2   City   State   Zip    
E-mail address:
Position Held:        
Reason For Leaving:         
Start Date     End Date      

Were you subject to the FMCSRs while employed by the previous employer?
      

Was the previous job position a safety sensitive function in any DOT regulated mode, subject to alcohol and drug testing requirements?  
        
      

Previous Employer 3

Company Name    Area Code   Phone Number    Address:   Street Address   Address Line 2   City   State   Zip    
E-mail address:
Position Held:        
Reason For Leaving:         
Start Date     End Date   

Were you subject to the FMCSRs while employed by the previous employer?
Yes   No   

Was the previous job position a safety sensitive function in any DOT regulated mode, subject to alcohol and drug testing requirements?
Yes   No   

Previous Employer 4

Company Name    Area Code   Phone Number    Address:   Street Address   Address Line 2   City   State   Zip    
E-mail address:
Position Held:        
Reason For Leaving:         
Start Date     End Date   

Were you subject to the FMCSRs while employed by the previous employer?
Yes   No   

Was the previous job position a safety sensitive function in any DOT regulated mode, subject to alcohol and drug testing requirements?
Yes   No   

Safety Performance History Records Request
Part 1 to be completed by prospective employee.

I,   First Name   Last Name , hereby authorize the previous employers listed in the above application to release and forward my Accident History within the previous 3 years from:   Today's Date  to SPE Group.

Signature        

SPE Group Drug & Alcohol Policy Acknowledgment

I,   First Name   Last Name   hereby acknowledge that I have read The above SPE Group Drug and Alcohol Policy including the clearing house addendum. I further acknowledge that I received training on the program and understand my obligation to register and create a clearinghouse account.     Signature   Date   

Substance Abuse - Employee Informed Consent and Release of Liability

I understand that as an employee of SPE Group(Company) and in accordance with company policy, and the Department of Transportation, I am required to participate in the substance abuse screen program pursuant to the written drug and alcohol policy. Further, I freely agree to submit a sample of my urine, blood and/or hair for chemical analysis, upon request. This consent is valid if I am unconscious or unable to respond to the request. I understand that this analysis will be performed by a laboratory licensed in Clinical Chemistry/Toxicology under the Clinical Laboratories Improvement Act (CUA), Healthcare Financing Administration, U.S. Department of Health and Human Services, and certified by the National Institute on Drug Abuse (NIDA) for analysis of urine specimens.
The purpose of this analysis is to determine or rule out the presence of non-prescribed or prohibited dangerous controlled substances in my urine, blood and/or hair.
I consent freely and voluntarily to this request for a urine, blood and/or hair specimen. I release Company, the collection personnel, the testing laboratory, their employees, agents and contractors from any liability whatsoever arising from this request to furnish my urine, blood and/or hair sample, the testing of my urine, blood and/or hair sample, and decisions made concerning my employment status, based upon the results of the analysis.
I understand that the laboratory will screen my urine, blood and/or hair sample by a method approved by the U.S. Food and Drug Administration (FDA). If positive, my urine, blood and/or hair sample will be confirmed by Gas Chromatography/Mass Spectrometry (GC/MS).
I have been informed that a documented chain of custody exists to ensure the identity and integrity of my provided specimen throughout the collection and testing process. The laboratory report will be reviewed by a licensed physician.
I understand I shall be subject to, and must comply with, the aforementioned company Drug and Alcohol Policy, a copy of which I have been provided and I have read or had explained to me in a language I can understand.   Signature   Date   

FMCSA Clearinghouse Drug & Alcohol Consent

I,     First Name   Last Name   hereby provide consent to SPE Utility Contractors and its subsidiaries to conduct a limited query of the FMCSA Commercial Drivers License Drug & Alcohol Clearinghouse to determine
whether drug and or alcohol information about me exist in the clearinghouse. This consent will remain in effect for the duration of my employment with SPE. I understand that if the limited query conducted under this consent indicates that drug and or alcohol violation information about me exist in the clearinghouse, FMCSA will not disclose the
information to SPE without first obtaining additional specific electronic consent from me. I further understand that if I refuse to provide consent to the company to conduct a Limited /full query the company must prohibit me from performing safety sensitive functions including
operating a commercial motor vehicle and it may terminate my employment.    Signature   Date   

Motor Vehicle Record Release (MVR) Consent

In conjunction with my employment, or volunteer work, at/with SPE Group (“the company”) I,First Name   Last Name ("the applicant") Consent to the release of my Motor Vehicle (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company. This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq.. “Federal Drivers Privacy Protection Act”, and is intended to constitute “written consent” as required by this Act.   Signature   Date   

Consent to A Background Check

I understand that, as a condition of my consideration for employment with SPE Group ("Company"), or as a condition of my continued employment with Company, it and its customers designated agents and representatives may obtain a background report that includes, but is not limited to, my creditworthiness or. similar characteristics, employment and education verifications, social security verification, criminal records, OMV records, drug and alcohol testing records any other public records and any other information bearing on my character, general reputation, personal characteristics and trustworthiness. I hereby authorize and consent to the Company's procurement of such a report and to use the information I have provided in my employment application. I authorize the complete release of these records or data pertaining to me which an individual, company firm, corporation or public agency may have. I understand that, pursuant to the Federal Fair Credit Reporting Act, the Company will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report. If I request I hereby release SPE Utility Contractors FD, LLC and its agents, officials, representatives or assigned agencies, including officers, employees or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.         Signature   Date   

Personal Protection Equipment Policy

SPE Group (" The Company") will supply all necessary Personal Protection Equipment (PPE) to Employee in accordance with the Collective Bargaining Agreement which may include rubber gloves, rubber sleeves, safety vest, safety glasses, hard hat, fire retardant clothing, bag and hot boots at no cost to the Employee.
If the PPE is damaged under normal working conditions and it is necessary to replace, Company will replace the damaged PPE at no charge to the employee. However, if any piece of PPE is lost, stolen, misused or abused through fault or neglect of the Employee, the Employee will be responsible for the cost of the replacement PPE.
If an Employee leaves Company (lay off, termination, or other reasons) the Employee will return all PPE to the Company. If the PPE is not returned, Employee authorizes Company to deduct the cost of such PPE from the Employee's final paycheck.         Signature   Date   

Employee Handbook Policies Acceptance

I understand that it is my responsibility to read the SPE Group Employee Handbook Policies Manual ("Manual") or to have someone explain them to me in a language that I understand. I agree to all the conditions set forth in the Manual. I also understand that I have reasonable expectation to believe these policies will remain in effect indefinitely. I understand that this Manual does not constitute an expressed or implied contract. I understand that the Company reserves a unilateral right to change, withdraw, or add to these policies at any time, and that the policies contained in this manual supersede and replace all previous personnel policies of the Company. I understand a copy of the personnel policies manual is available at the office.     Signature   Date   

Conditional Job Offer

SPE Group ("Company") is making a Conditional Job Offer for the position applied
for based on several contingencies, including but not limited to the following: 

• Successful verification and/or completion of the employee's reference checks, education, employment experience, licenses, certifications, state police criminal history record check, driver's license and other screening procedures used to assess the applicant's overall suitability to be employed for this position.
• Applicant's full cooperation with the production of references, obtainment of signed releases, consent forms, criminal history records, and the obtainment of any other information required by employer policy or state or federal law. Failure to comply fully with all of the requirements within 10 business days will result in the automatic withdrawal of this offer. If the required screenings and background checks are not completed within 10 business days, then this conditional offer of employment shall be withdrawn.
• Successful completion of the medical examination with drug test screening. Such health screenings will be conducted at a health care facility, clinic or health care professional office selected by Company
• Applicant's ability to submit appropriate documentation establishing identity and his/her right to be lawfully employed in the United States as determined by the Immigration Reform and Control Act of 1989.
• Employer's ability to verify the accuracy and truthfulness of all of the information provided on the job application and throughout the hiring process.

Any information gathered from the background check screening and health screening shall be kept confidential and disclosed only to Company's personnel involved in hiring decisions. The information may also be disclosed to state and federal agencies as authorized by state or federal law.

This conditional job offer does not alter in any way the at-will status of employment.   Signature   Date   

Safety Performance History Records Request

By electronically signing below, I authorize SPE Group and its insurers to investigate my license(s). 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 that I have the right to: 

• Review information provided by current/previous employers; 
• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree in the accuracy of the information.   Signature   Date   

Alcohol And Controlled Substance Testing Records Release

By electronically signing below, I authorize my prior employers to release and forward the information requested by concerning my Alcohol and Controlled Substances Testing records within the previous 3 years from the date of this application. I understand that in compliance with 49 CFR 40.25(g) and 391.23(h) the information provided by my previous employer must be made in written form that ensures confidentiality, such as fax, e-mail or letter.   Signature   Date   

Per Diem and Travel Expenses


By signing this employment application, you acknowledge and agree that you may receive per diem and/or travel expense reimbursement during your employment. Unless your per diem is mandated by the CBA, such reimbursements may be subject to tax reporting requirements. It is your responsibility to maintain accurate records and receipts to support all per diem and/or travel expense reimbursement. We request that you provide receipts to us to support the reimbursement for travel and lodging expenses incurred by you. An application to upload receipts will be provided.  
In the event that you are unable to provide adequate documentation, such as receipts or other substantiating evidence for travel and/or per diem expenses, you understand and agree that you will be solely responsible for any resulting tax liabilities or consequences. The Company shall not be held liable for any taxes, penalties, or fines incurred due to the lack of proper documentation.
We strongly advise all employees to keep detailed records of their per diem expenses to ensure compliance with tax regulations and to avoid any potential tax liabilities.
By signing below, you acknowledge that you have read and understood the above disclaimer regarding travel reimbursement and/or per diem expenses are your responsibilities for tax reporting purposes.



First Name   Last Name   Signature   Date   

Employee Commitment

Dear Employee,                                      

SPE challenges each and every employee to do their part to go home safely, not only for SPE, but for yourself. SPE looks for the participation from every employee to help it meet its safety goals. Below is a Statement from the Company that we ask each employee to read, work and live by while employed at SPE or any other employer that you make work for in the future.

LIKE EVERY SUCCESSFUL COMPANY, SPE IS JUDGED BY THE ACTIONS OF ITS EMPLOYEES. THIS INCLUDES OFFICE STAFF, FIELD WORKERS AND MANAGEMENT.

YOU, AS AN EMPLOYEE, ARE NOT ONLY REPRESENTING SPE, BUT
MORE IMPORTANTLY, YOU ARE REPRESENTING YOURSELF.
YOU, ARE THE FACE OF SPE TO OUR CLIENTS, OUR VENDORS, THE PUBLIC AND YOUR CO-WORKERS.

SPE ASKS THAT YOU TO MAKE THE FOLLOWING COMMITMENT
EVERYDAY:

* I WILL WORK SAFE;
* I WILL BE PROUD OF THE QUALITY OF MY WORK;
* I WILL BE RESPECTFUL OF THE TOOLS AND EQUIPMENT I USE;
* I WILL BE PROFESSIONAL; AND
* I WILL WORK AS A TEAM.

Please join all employees and commit to providing safe, quality and timely services to our clients.

First Name   Last Name   Signature   Date   

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States
2. A noncitizen national of the United States (See instructions)    
3. A lawful permanent resident (Alien Registration Number/USCIS Number)    4. An alien authorized to work until    (mm/dd/yyyy)   

Some aliens may write "N/A" in the expiration date field. (See instructions)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number: 
OR
2. 1. Alien Registration Number/USCIS Number: 
OR
3. Foreign Passport Number:      
Country of Issuance:      



Employee Signature    Today's Date    

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator    Today's Date     Last name (Family Name)    First Name (Given Name)    
Street Address   Address Line 2   City   State   Zip   

I,   First Name   Last Name , certify that I have read and to the best of my knowledge the information contained on this application is true. I agree to be bound by the terms and conditions stated herein. I understand that nothing contained in this employment application is intended to create a contract between me and this Company for either employment or any benefits, and further understand that if an employment relationship subsequently is established, I will have the right to terminate my employment at any time and the company will have a similar right. In addition, I understand that no promise, representation, or agreement contrary to the foregoing is binding on the company unless made in writing and signed by me and the President of the Company. I understand that I may be terminated in the event anything in this statement or other employment forms is incorrect. I authorize SPE Group and its insurers to investigate my license(s). 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 that I have the right to: Review information provided by current/previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; have a rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree in the accuracy of the information. I authorize my prior employers to release and forward the information requested by concerning my Alcohol and Controlled Substances Testing records within the previous 3 years from the date of this application. I understand that in compliance with 49 CFR 40.25(g) and 391.23(h) the information provided by my previous employer must be made in written form that ensures confidentiality, such as fax, E-mail or letter.

THIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

DateSignatureFirst NameLast Name