231 Old Philadelphia Pk., Ste. 1 Douglassville, PA 19518

NOTICE REGARDING JOB APPLICANT AND EMPLOYEE DRUG AND ALCOHOL TESTING

C. .S. Garber & Sons, Inc. has an established policy for drug and alcohol use on the job as well as an established drug and alcohol testing protocol to help ensure a work environment free of the misuse or unlawful use of controlled substances. Under this policy, C. S. Garber & Sons, Inc. screens job applicants and employees for alcohol and drug abuse. Applicants for employment with the Company who hold or who are expected to obtain a Commercial Drivers License (CDL) as a condition of employment are required to undergo urine specimen drug testing and (under company authority and at the company's discretion) breath alcohol testing. Applicants refusing to allow pre-employment testing for substance abuse will be removed from consideration for employment. Applicants who test positive for illegal drugs or controlled substances (except the physician-prescribed use, of certain prescription drugs verifiable by current prescription) or a breath alcohol test result of 0.04 BAC or higher will not be hired. Applicants who test positive may not be reconsidered for employment. Employee involvement in a work-related accident is considered cause for drug and alcohol testing. Unexplained deterioration in job performance or an indication of drug or alcohol abuse will be considered "probable cause" for drug and alcohol testing. C. S. Garber & Sons, Inc. also reserves the right to test employees under "preassignment" and "random selection" in all job categories where liability risks or safety of others is involved. After acceptance for employment, employees who recognize that they have developed a drug or alcohol dependency and volunteer for treatment may be given an opportunity for rehabilitation through our Employee Assistance Program. C. S. Garber & Sons, Inc. requires that employees treated for substance abuse due to a positive drug or alcohol test or a non voluntary supervisory-directed referral be tested periodically following completion of a treatment program. Testing may also occur during treatment if recommended in an independent evaluation for substance abuse. Refusal to be tested during or following treatment will be grounds for discipline up to and including employment termination. Confirmed use of drugs or unacceptable alcohol levels in any testing will be grounds for immediate employment termination. This policy does not apply to the use of controlled drugs within the limits of a valid prescription provided the taking of such medication does not impair the safe performance of the employee's work.

C.S. Garber & Sons, Inc. Notice Regarding Job Applicant Continued

(Please remove this page, complete and return to Company Official I have read and understand the above notice. I specifically authorize the results of the pre-employment/preplacement urine specimen drug test and breath alcohol test released to the representatives of ChemQuest, Inc. (a third party administrator) and C.S. Garber & Sons, Inc Such results shall be confidential and will only be released in the future with my expressed written permission.

231 Old Philadelphia Pk., Ste. 1 Douglassville, PA 19518

Application for Drill Helper Pump Helper Water Conditioning Mechanic

Are you a United States Citizen?

Do you know anyone employed here?

Have you ever been convicted for a crime?

List 2 people who know you, address & phone numbers (not employers or relatives) 1.

APPLICATIONS FOR MECHANIC'S POSITION ONLY - (others skip this section) Do you have a State Inspection Certificate?

APPLICATIONS FOR DRILL HELPER OR PUMP HELPER ONLY - (others skip this section)

The following information is required by the "Federal Motor Carrier Safety Regulations". If you do not complete it, we cannot consider your application for employment.

If yes, you must furnish a statement in detail telling the circumstances and facts of any denial, revocation, or

List all motor vehicle accidents you were involved in during the past 3 years.

List all motor vehicle violations (other than parking) you were guilty of during the past 3 years. Date Offense Location

List the equipment you have experience operating.

Trucks under 10,000# GVW Trucks 10,000 - 26,000# GVW Trucks over 26,000# GVW Trucks pulling trailers

Explain where/in what capacity

Have you taken the Motor Carrier Written Exam?

Answer in text area below.

 

 

A pre-employment physical exam is required by our company doctor.

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.

*We are required by Section 391.23 of the Motor Vehicle Regulations to investigate your previous employment record. The previous employers that you listed will be contacted for this purpose. *