Employment Application
Fill the form below accurately indicating your potentials and suitability to job applying for.
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Training and Certifications
References
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Tax Withholding (W-4) Information
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Certification and Authorization
Please read and sign below to certify the accuracy of your information.
Terms and Conditions
I certify that the information provided is true and complete to the best of my knowledge. I authorize the company to verify my employment eligibility and process my application.
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Employment Eligibility Verification Form
Department of Homeland Security U.S.Citizenship and Immigration Services
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Missouri Job Application & Tax Withholding Form
Apply for employment and provide your Missouri state tax withholding details in one convenient form.
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WOTC Eligibility Screening
Answer the following questions to help determine your eligibility for the Work Opportunity Tax Credit program.
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Employment Authorization and Acknowledgement.
Employment Authorization and Acknowledgement Payroll Authorization: Employees have the option of receiving wages by direct deposit, paper check or a payroll debit card. I hereby authorize my employer, SafeChoice Laborforce, (“SC”), to directly deposit my periodic wages/compensation payments, net of required tax withholdings, other required withholdings or authorized deductions, into my designated bank account(s) or selected pay card. In the event SC deposits funds erroneously into my account(s), I authorize SC to debit entries and adjustments for any credit entries made in error to my account(s) but not to exceed the original amount of erroneous credit. I further agree to not hold SC responsible for any delay or loss due to incorrect or incomplete information supplied by my financial institution, or myself and for reasons such as (1) not properly activating my pay card (2) an error made by my financial institution depositing funds to my account. This agreement will remain in effect until revoked by my written request. I understand that I must immediately notify the branch before closing any/all account(s) provided while this authorization is in effect and for any other issues. For any issues with pay cards and accessing funds I will refer to the customer service number on the back of the pay card. Employment Verification Authorization: I authorize SC, or any representative thereof, to contact my present and past employer(s) for the purpose of confirming my length of employment, and other relevant data. I also authorize SC, or any representative thereof, to conduct investigative background inquiries on me, to include consumer, credit, criminal, civil, driving, and other reports as needed, on a continuing basis as it relates to my employment. I also authorize company representatives to review any current or prior industrial injury claims on file with worker's compensation carriers, and other medical providers in order to determine my physical capabilities in regard to potential job assignments. Release of Claims Against SC Customers: I understand that SC provides temporary workers for its customers to work at the customer’s designated job site. In accepting any work assignment, I acknowledge that I am a temporary worker of SC and not an employee of the Company’s customer. If I am ever injured in the course of any work assignment for SC, I agree that I will look only to the Company’s Worker’s Compensation coverage and not the Company’s customer for any recovery. For myself, and on behalf of my heirs, executor, personal representatives and assigns, I waive, release, and forever discharge any claim that I may now have or that may later accrue against any customer of the Company which directly or indirectly arises out of any injuries which may occur while I am on a work assignment for the Company. In signing this Release, I understand that I am not waiving or releasing any claims that I may have against the Worker’s Compensation coverage provided by SC. Deduction Consent: In an effort to ensure that temporary employees are able to reach their respective job sites, SC may help facilitate a “carpooling” arrangement between employees or otherwise assist in providing transportation. I acknowledge that if I choose to participate in carpooling, I do so voluntarily and neither I nor other participants are authorized agents of SC. I indemnify and hold SC harmless for all injuries and/or damages I may suffer as a result of such ride sharing. I am free to arrange for my own transportation to and from the jobsite. I also authorize SC to deduct, from my wages, charges for equipment and/or any monetary advances or loans I may be given. Conditions and Certifications: In consideration of my employment, I agree to conform to the rules and regulations of SC and I understand that my employment by SC may be terminated at any time by SC or me with or without notice, for any reason. I understand that no Manager, or any other employee or representative of SC other than the President of SC, has any authority to enter into any agreement for employment for any specified period of time, or to make any other agreement contrary to any of the foregoing. Confidentiality Statement: Employees and former employees are prohibited from releasing to any other party any information whatsoever about SC which is of a confidential nature or which could be deemed to constitute a “trade secret.” Employees or former employees are further prohibited from using, in any manner whatsoever, information which is confidential proprietary, or privileged, whether for their personal benefit or gain, or for that of any other person. Any information which has not been disclosed publicly in writing should be treated as confidential and proprietary. I understand the duties, including physical requirements, of the position for which I am applying with SC and I certify that I am capable of performing the required tasks with or without reasonable accommodation. If after I am hired I am requested to perform work which I am unable to perform due to a disability, I will notify SC so that we may discuss the options for any reasonable accommodation. I understand that SC does not tolerate racial or sexual harassment or discrimination. I have read and understood SC’s policy against harassment and discrimination. I understand that I should report any actual racial or sexual harassment or discrimination to any branch personnel or SC’s management as provided in the policy, and that I am protected against retaliation for having done so. Policy Regarding Dispatch Procedure: I understand that I am not required to work on any particular day and whether I report in to the SC office is always my choice. Whenever I wish to register my availability to work, I will visit the office and sign in. I know that SC is not required to find work for me and is not required to contact me in any way in order to make work available to me. If I do not report to the office and sign in, SC may assume that I am not available for work that day. I understand that SC follows a “best match for dispatch” policy and not a “first in-first out” policy. I understand that after receiving a job assignment, I am free on my own time to leave the office and do as I wish until the assignment starts. I understand the importance of never being late for a job assignment. I agree to notify the dispatch Manager of any physical limitation, prescribed medication, previous injury, or pre-existing condition which may impair or limit my ability to perform an offered job assignment. If I have a ‘Repeat Ticket’ (defined as a request to return to the same job at a later date), I know that I am required to report my availability to SC in the manner indicated by the dispatcher at least one (1) hour before the scheduled start time and that if I do not, then SC may assume that I am not available to return to work. Employment: I understand and acknowledge that my employment with SC is on an “AT WILL” day-to-day basis. That is, at the end of the workday, I will be deemed to have quit until I report to the office at a later date, receive a new work assignment, and actually commence work on a new assignment. I acknowledge that I am not employed by SC while traveling to and from an assignment. I understand that I am employed by SC only during the time period in which I am actually at an assignment and working. Failure to request a new assignment may affect eligibility for unemployment compensation. I understand that merely registering my availability to work does not constitute employment, and I am not reemployed until I actually commence work at a new work assignment. Regardless of my employment status, I understand that I will not be entitled to receive any fringe benefits of any type from SC, including such things as health insurance, pension plan, and vacation. I understand the significance of my exclusion from these programs and irrevocably agree to my exclusion. Safety: I have completed the safety training required as part of SC’s application process. I certify that I understand the content of the training I have received.
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Equal Employment Opportunity
A. B. C. D. E. F. SafeChoice Laborforce (“the Company”) is committed to fair treatment in employment and is an equal opportunity (EEO) employer. We provide an honest and welcome environment for all our employees. SafeChoice Laborforce strives to match the most qualified workers to the needs of our valued clients regardless of race, color, religion, age, sex, gender, sexual orientation pregnancy, national origin, disability, or any other legally protected status under federal, state, or local laws. SafeChoice Laborforce’s policy is to hire, train, evaluate, and provide promotions and advancement opportunities to all of our employees based generally on qualifications, quality of work, performance, and other non-discriminatory factors. SafeChoice will not honor any customer request to violate this policy. SafeChoice will explain to any customer making a discriminatory request that such requests cannot be filled, and that SafeChoice will provide that customer with the best qualified temporary employee available. The law and SafeChoice policy prohibit coworkers and third parties, as well as supervisors and managers, from engaging in any discriminatory conduct that violates and federal, state or local laws. SafeChoice complies with federal and state equal opportunity laws and strives to keep the workplace free from all forms of harassment, including sexual harassment. SafeChoice considers harassment and bullying in all forms to be a serious offense. In addition, the Company prohibits retaliation against individuals who raise complaints of discrimination or harassment or who participate in workplace investigations. Harassment Prevention: The Company prohibits harassment on the basis of race, color, religion, age, sex, gender, sexual orientation pregnancy, national origin, disability, or any other legally protected status under federal, state, or local laws. The Company does not tolerate harassment of employees because of a protected characteristic in the workplace or in a work-related situation. The Company's policy prohibiting harassment applies to all persons involved in the operation of the Company. The Company prohibits harassment, bullying, disrespectful or unprofessional conduct by any employee of the Company, including supervisors, managers and co-workers. The Company's anti-harassment policy also applies to vendors, customers, independent contractors, unpaid interns, volunteers, persons providing services pursuant to a contract and other persons with whom you come into contact while working. Behavior that demonstrates mutual respect is expected of all employees at all times under all circumstances. Prohibited harassment, bullying, disrespectful or unprofessional conduct includes, but is not limited to, the following behavior: • Verbal conduct such as epithets, derogatory jokes or comments, slurs or unwanted sexual advances, invitations, comments, posts or messages; • Visual displays such as derogatory and/or sexually-oriented posters, photography, cartoons, drawings or gestures; • Physical conduct including assault, unwanted touching, intentionally blocking normal movement or interfering with work because of sex, race or any other protected basis; • Threats and demands to submit to sexual requests or sexual advances as a condition of continued employment, or to avoid some other loss and offers of employment benefits in return for sexual favors; • Retaliation for reporting or threatening to report harassment; and • Communication via electronic media of any type that includes any conduct that is prohibited by state and/or federal law or by company policy. Sexual harassment does not need to be motivated by sexual desire to be unlawful or to violate this policy. For example, hostile acts toward an employee because of his/her gender can amount to sexual harassment, regardless of whether the treatment is motivated by sexual desire. Prohibited harassment is not just sexual harassment but harassment based on any protected category. Sexual harassment warrants special emphasis and will not be tolerated by the Company. Sexual harassment may take various forms. It may include behavior listed above with a sexual connotation, but also includes unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when: • Submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment; • Submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; or Such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment. Non-Discrimination: The Company is committed to compliance with all applicable laws providing equal employment opportunities. This commitment applies to all persons involved in Company operations. The Company prohibits unlawful discrimination against any job applicant, employee or unpaid intern by any employee of the Company, including supervisors and coworkers. Anti-Retaliation: The Company will not retaliate against employees for filing a complaint or participating in any workplace investigation and will not tolerate or permit retaliation by management, employees or co- workers. Reasonable Accommodation: To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship or a direct threat would result. Any job applicant or employee who requires an accommodation in order to perform the essential functions of the job should contact a Company representative with day-to-day personnel responsibilities and discuss the need for an accommodation. The Company will engage in an interactive process with the employee to identify possible accommodations, if any, that will help the applicant or employee perform the job. Anyone who requires an accommodation of a religious belief or practice (including religious dress and grooming practices, such as religious clothing or hairstyles) should also contact a Company representative with day-to-day personnel responsibilities and discuss the need for an accommodation. If the accommodation is reasonable and will not impose an undue hardship, the Company will make the accommodation. The Company will not retaliate against you for requesting a reasonable accommodation and will not knowingly tolerate or permit retaliation by management, employees or coworkers. Complaint Process: If you believe that you have been subjected to conduct in violation of the policies detailed above, including the Company’s policies against harassment, discrimination, retaliation or other prohibited conduct, and/or have witnessed or are aware of violations of the Company’s EEO and anti- harassment policies, you should bring your complaint to your supervisor or to the Company’s HR Director, Legal Director, or President, as soon as possible after the incident. You can bring your complaint to any of these individuals. Please provide all known details of the incident or incidents, names of individuals involved and names of any witnesses. It would be best to communicate your complaint in writing, but this is not mandatory. The Company encourages all individuals to report any incidents of harassment, discrimination, retaliation or other prohibited conduct forbidden by this policy immediately so that complaints can be quickly and fairly resolved. Supervisors must refer all complaints they receive or become aware of involving harassment, discrimination, retaliation or other prohibited conduct to either the Company Legal Director or Company President, so the Company can try to resolve the issue. When the Company receives allegations of misconduct, it will immediately undertake a timely, thorough and objective investigation of the allegations in accordance with all legal requirements. The Company will reach reasonable conclusions based on the evidence collected. The Company will maintain confidentiality to the extent possible. However, the Company cannot promise complete confidentiality. The employer's duty to investigate and take corrective action may require the disclosure of information to individuals with a need to know. Therefore, confidentiality cannot be promised, although we will use our best efforts to keep the matter as confidential as possible and ensure that retaliation does not take place. The Company is responsible for investigating complaints of harassment; however, employees must recognize and exercise their responsibility for bringing these matters to our attention. The Company can’t fix an issue it doesn’t know about! Complaints will be: • Responded to in a timely manner • Kept confidential to the extent possible • Investigated impartially by qualified personnel in a timely manner • Documented and tracked for reasonable progress • Given appropriate options for remedial action and resolution • Closed in a timely manner If the Company determines that conduct in violation of its policies against harassment, discrimination, retaliation or other prohibited conduct has occurred, appropriate and effective corrective and remedial action will be taken in accordance with the circumstances involved. The Company also will take appropriate action to deter future misconduct. Any employee determined by the Company to have violated its policies against harassment, discrimination, retaliation or other prohibited conduct will be subject to appropriate disciplinary action, up to, and including termination. Employees should also know that if they engage in unlawful harassment, they can be held personally liable for the misconduct. The Company prohibits retaliation against any employee who brings a complaint of harassment or discrimination to the attention of management or who participates in any workplace investigation.
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Equal Employment Opportunity (2)
Working Hours/Meal Periods and Rest Periods The Company provides employees with details concerning the job assignment and work hours. Some assignments involve an eight-hour work day and some may be shorter and may require overtime. A 30-minute meal free period is provided to all non-exempt employees who work a full workday or as otherwise required by any applicable state law. Meal periods are duty-free and uninterrupted. Employees that work ten-hour workdays are provided additional meal period/rest periods or as otherwise required by any applicable state law. Per diem is not offered except as required by local and state laws. If there are any concerns at any time please advise the Company. The Company authorizes and permits all non-exempt employees to take rest periods. Employees may generally take two 10-minute rest periods in a full work day; one in the morning and one in the afternoon, or as otherwise required by applicable state law. Employees are paid for these rest periods and do not clock in or out for the rest periods. Employees may not combine their rest periods with any meal periods and may not skip rest periods so they can leave work early. Employees that are unable to take a 10-minute rest period, or that have their rest period interrupted, must inform their immediate supervisor or Company immediately. Timekeeping Policy All employees are required to accurately record all hours worked. Unless otherwise notified, employees are required to accurately record their work time through the use of a time card, an electronic time-keeping system or a handwritten record. Employees are required to submit their time records promptly following the close of business for the day or the specified pay period so that their time records can be reviewed by the host supervisor and branch employee before paychecks are processed for the pay period. Employees are required to accurately record all work hours to ensure being paid timely and accurately for all hours worked as required by applicable law. “Hours worked” is defined by law as all-time an employee is subject to the control of an employer, and includes all time that an employee is suffered or permitted to work, whether or not required to do so. Employees may be asked to sign their time cards and confirm in writing that their time cards are accurate and that they have been relieved of all duty and otherwise provided all of their meal periods and rest breaks during a particular pay period, or in the alternative, to identify any meal periods or rest breaks that they have missed. At no time may any employee perform off-the-clock work or otherwise alter, falsify or manipulate any aspect of their time-keeping records to inaccurately reflect or hide hours worked, meal periods taken or time spent working during meal periods. The obligation to accurately record all hours worked does not relieve employees of their obligations to obtain advance approval from a manager or supervisor before working overtime or hours beyond the regular work schedule. Employees who work beyond their regularly scheduled work hours, including overtime or off-schedule hours, without prior authorization by a manager or supervisor are subject to disciplinary action, which may include termination of employment. Employees will be informed on their first day on the job whether they are required to record their work time by a time clock, a time sheet or some other method. Whatever the method of time-keeping, employees are expected to follow the established procedures in keeping an accurate record of hours worked. Any changes or corrections to an employee’s time card or time record must be initialed by the employee and a manager or supervisor. Under no circumstances may any employee punch or record another employee’s time card. Paycheck Errors The Company takes all reasonable steps to ensure that employees receive the correct amount of pay in each paycheck and that employees are paid promptly on the scheduled paydays. In the unlikely event there is an error in the amount of pay, the employee should promptly bring the discrepancy to any SafeChoice Laborforce employee. SafeChoice Laborforce prides itself in making safety our X Factor. We encourage the reporting of near misses in the workplace, hazards, and/or safety suggestions. Workers’ Compensation If you suffer a work-related injury or illness, no matter how minor, you must immediately report it to your supervisor and to Priority Care PC365 at 1-855-309-0002 so that you can receive the proper treatment and the Company can take steps to help prevent similar injuries or illnesses from occurring. This line is available 24 hours a day, 7 days a week and 365 days a year. The Company's workers compensation program covers all eligible employees. For more information, please contact any employee in the Corporate Workers’ Compensation Department. Drug Free Work Place It is the purpose of SafeChoice Laborforce (the Company) to help provide a safe and drug-free work environment for our employees and clients. The Company is concerned about the use of alcohol and illegal drugs as it affects the workplace. Use of these substances on the job can adversely affect an employee’s work performance, efficiency, safety, and health. In addition, the use or possession of these substances on the job constitutes a potential danger to the welfare and safety of other employees and exposes the Company to the risks of property loss, damage, and injury to others. The following rules and standards of conduct apply to all employees either on Company property or during the workday (including meal periods and rest breaks). The Company strictly prohibits the following: • Possession, use of, or being under the influence of alcohol; • Distribution, sale, or purchase of an illegal or controlled substance; • Possession, use of, or being under the influence of an illegal or controlled substance, unless under the direction of a certified physician. This policy also applies to the possession, distribution, use of, or being under the influence of marijuana, regardless of its legal status. Violation of the above rules and standards of conduct will not be tolerated. The Company may bring violations of this policy to the attention of appropriate law enforcement authorities. Any employee who is using prescription or over-the-counter drugs that may impair the employee’s ability to safely perform his or her job duties, or that may affect the safety or well-being of others, is encouraged to discuss any potential side effects and work restrictions with his or her health care provider before starting or resuming work. If the employee has work restrictions, he or she should discuss them with his or her supervisor. The employee should not, however, disclose any underlying medical condition requiring the prescription or medication. The Company may conduct drug and/or alcohol testing under any of the following circumstances (if allowable under your State’s laws): 1) RANDOM TESTING: Employees may be selected at random for drug and/or alcohol testing at any interval determined by the Company, if permitted by applicable law. As used in this policy, “random testing” means a method of selection of employees for testing, performed by an outside third party. The selection will result in an equal probability that any employee from a group of employees will be tested. Furthermore, the Company has no discretion to waive the selection of an employee selected by this random selection method. 2) FOR-CAUSE TESTING: The Company may ask an employee to submit to a drug and/or alcohol test at any time that there is reasonable suspicion that the employee may be under the influence of drugs or alcohol, including, but not limited to, the following circumstances: unusual conduct on the employee's part that suggests impairment or influence of drugs or alcohol, negative performance patterns, or excessive and unexplained absenteeism or tardiness. 3) 4) POST-ACCIDENT TESTING: Any employee whose conduct could have contributed to a workplace incident that harmed or could have harmed employees may be asked to submit to a drug and/or alcohol test. If such testing is conducted, all employees whose conduct could have contributed to the incident will be tested. REFUSAL TO UNDERGO TESTING: Employees who refuse to submit to testing may be subject to immediate discharge. Questions regarding this policy should be directed to Human Resources or the Legal Director at 816- 903-5555. Firearms, Weapons, and Explosives Policy A. B. C. D. E. Firearms, weapons, and explosives are not permitted in the corporate office, branch offices, or in any company owned or leased vehicle at any time. Including any place, the company business is being conducted, such as vendors, client locations, client work-sites. This applies to concealed and openly carried weapons. Employees will not bring or possess firearms, weapons, or explosives on company premises, unless otherwise permitted under state law, in which case employees may bring firearms on company premises but must keep them secured in their personal locked vehicle at all times. Possession includes carrying a firearm, weapon, or explosive on your person or keeping the same anywhere on company property. Weapons include, but are not limited to, guns, batons, brass knuckles, knives or swords with blades, explosives, and any chemical whose purpose is to cause harm to another person. This list is non-exhaustive. The Company reserves the right to inspect, search and monitor employees and their personal property on company, client locations, client work-site or any other work facility premises while performing work to ensure compliance with this policy. Company property including but not limited to lockers, phones, computers, USB drives, files, emails, voicemails, tablets, desks, workstations, work areas, vehicles or machinery remains under control of the Company and is subject to inspection at any time with or without notice. The Company assumes no responsibility for the loss of, damage to your property maintained on Company or customer premises or company owned or leased vehicles. Failure to submit to a search may result in discipline, up to and including immediate termination. Any violation of the Firearms and Weapons Policy can lead to discipline, up to and including immediate termination. Amendments: This Handbook is reviewed, amended, and revised if necessary, on a yearly basis. Employees may or may not be provided with notice of all amendments and revisions to this Policy.
Employee Certification
I have received my copy of SC’s Policies. I understand and agree that it is my responsibility to read, familiarize myself, and abide by the policies, practices, guidelines, and procedures contained in the disclosure. If I do not understand any of the policies contained within, I understand I have the responsibility to contact human resources regarding any questions. I understand that SC can change any and all policies or practices at any time. I also understand that if the disclosure is translated into another language, and if there are any differences between the translated disclosure and the English version, the English version controls. I further understand that my employment with SC is at-will and that I or SC may terminate employment at any time, with or without reason or notice. The at-will policy cannot be altered by any Company employee other than Corporate HR and such agreement must be in writing signed by both me and the President or CEO. I have not entered into such an agreement.
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Worker Compensation Fraud Policy
It is SafeChoice Laborforce (“SC”) policy to support workers’ compensation laws and systems. We are absolute proponents of Workers Compensation for the legitimately injured employee and will work to help any SC employee injured on the job to receive appropriate medical treatment and is helped to return to work as quickly as possible. It is also SC’s policy to prosecute to the fullest extent of the law any individual who is found to be committing workers’ compensation fraud or collaborating with individuals attempting to defraud the workers’ compensation system. SC will cooperate in the successful prosecution of anyone engaged in workers’ compensation fraud. It is understood by the employee and employer alike, that workers’ compensation fraud can be punishable by heavy fines and even jail time. SC provides all employees who experience an on the job injury or illness with workers’ compensation insurance coverage. This insurance applies to all SC employees regardless of whether they are full-time, part-time or temporary. Workers’ compensation coverage provides an employee injured on the job with payment of related medical expenses and partial salary continuation (as mandated by state law). SC has a preferred provider network to furnish medical treatment for work-related injuries. SC has a mandatory Return to Work program for employees who have been released to work by their medical provider to light or restricted duty. The HR Department of SC, in cooperation with the Branch Managers, coordinates all aspects of the transitional Return to Work Program. Temporary work assignments may be offered when available and tailored to the individual physical capabilities of each injured employee until they are medically stable or have reached Maximum Medical Improvement. An injured employee will only be asked to perform those job functions their medical provider determined as safe and appropriate. It is the injured employee’s responsibility to keep and schedule any physical therapy and follow up medical appointments related to the on the job injury. SC strives to reduce workplace hazards and eliminate on the job injuries by maintaining a safe workplace and encouraging safe workplace practices. Safety/Injuries: I agree to immediately report to SC and my Worksite Employer any accidents or injuries I suffer while working or while on my Worksite Employer’s premises. I further agree to follow all safety rules and regulations established by either SC or my Worksite Employer and realize that failure to do so may alter any workers’ compensation benefits provided to me. In recognition of the fact that any work related injuries which might be sustained by me are covered by state Workers’ Compensation statutes, and to avoid the circumvention of such state statutes which may result in suits against the customers or clients of SC based on the same injury or injuries, and to the extent permitted by law, I hereby waive and forever release any rights I might have to make claims or bring suits against any client or customer of SC for damages based upon injuries covered under Workers’ Compensation statutes. PPE: You are to wear safety equipment if the assignment requires it. If injury occurs and you were not wearing your safety equipment, your workers’ compensation may be denied. Drug and Alcohol: I specifically agree to post-accident drug/alcohol testing after every work injury regardless of whether I am able to give consent at that time. This document is my authority to post-accident drug/alcohol testing in all instances. SC is in agreement with the Federal Government that marijuana is a controlled substance and will not recognize medical marijuana as a legitimate prescription. A positive test result for marijuana will be treated the same as any other positive test result, even if an employee has a medical marijuana prescription. Horseplay: Horseplay is prohibited in the workplace. Workers’ compensation benefits may be denied for injuries that occur as a result of horseplay. Heights: Employee acknowledges and agrees that performing work above ground level is not permitted whatsoever (ie., that requires employees to climb ladders, access heights above ground level, or utilizing lifts, etc.) without prior notice to and written consent from SC. Crystalline silica: OSHA prohibits any and all “Dry” sweeping of floors, drilling, chipping, grinding, crushing and cutting of stone, concrete, brick, mortar, ect. Wet-methods (use of water) or sweeping compounds is mandatory. Various tasks require the use of respiratory protection. Ask your supervisor or a SC representative if respiratory protection is needed for a specific task you are performing. The standard, nuisance-type dust mask does not constitute respiratory protection, and is not a sufficient means of respiratory protection against silica dust as outlined in OSHA standard CFR 1926.1153. Workers Compensation Benefits: In order to receive workers compensation benefits, you need to know and to follow the rules and obligations of the workers' compensation system. The rules include, but are not limited to: • Your injury must be proven to have been job related, occurring in the course of your work and because of it. • You must IMMEDIATELY report any and all injuries that occur while you are at work to your SC representative. • Workers’ compensation claimants MUST submit to a 10 panel post-accident drug-screen. • If you are receiving any type of disability compensation as a result of a workers’ compensation claim, you must notify the insurer of any and all employment, social security, cash or unemployment compensation (including income-in-kind). • If you do not report earned income while collecting disability benefits, your benefits could be discontinued. • Any person knowingly providing false or misleading information in a claim for workers’ compensation benefits will be immediately terminated and may be subject to criminal prosecution. • If you have questions about your benefits or the above rules, contact SC’s Global Safety and Risk Management Team.
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Arbitration Agreement
This Agreement shall be governed by the laws of the State in which the employee was hired, without regard to that state’s conflict-of-laws rules. Any dispute that arises out of or relates to the Employee’s employment by Company, and cannot be resolved independently by Company and Employee, shall be resolved through binding individual arbitration conducted by Judicial Arbitration & Mediation Services (JAMS) or the American Arbitration Association (AAA) with such employment arbitration rules or other rules to ensure that the arbitration proceeds subject to the following requirements: (a) before a single, neutral arbitrator; (b) with discovery to the same extent as is allowed under the state’s Code of Civil Procedure; (c) with a final decision in the form of a detailed, reasoned opinion sufficient to enable judicial review; (d) with no limitations on the type of relief available under the laws relating to the claim advanced in arbitration; (e) that the Company be solely responsible for all types of costs associated with arbitration that the employee would not have to pay if the proceedings were in court, including arbitrators fees, case-management fees, and other expenses necessary to provide the arbitral forum; and (f) to the greatest extent allowed by the applicable state law, the employee shall have the same appellate rights as the employee would if the arbitrated claim had been brought in the state’s state or federal courts. Except as noted elsewhere in this agreement this arbitration provision applies to all claims whatsoever arising in connection with Employee’s employment with the Company, including claims arising under the Age Discrimination in Employment Act; the Family and Medical Leave Act; the Worker Adjustment and Retraining Notification Act; Title VII of the Civil Rights Act of 1964, or any other state or federal anti-discrimination laws; the Americans with Disabilities Act; the Employee Retirement Income Security Act; the Equal Pay Act of 1963; and/or any other local, city, county, state or federal statutes, laws, regulations or ordinances. This agreement shall not interfere with an Employee’s right to file a claim with the Equal Employment Opportunity Commission or similar state or federal agency.
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