I understand that if my application is considered, I will be required to successfuly complete a drug screening test, an agility test, and a physical examination, including procedures designed to determine whether I can safely perform the essential functions of the job for which I have applied (the “Test”).
The drug screen shall be conducted at the office of Don Baer at Quality Assured Companies.
The medical exam shall be conducted at the Pro Medical and includes, but is not limited to:
a. DOT Physical
b. Audiogram
c. Fit Test
d. Chest X-Ray with ILO Read & Reg Read
Upon completion of medical testing and review, my medical records shall be forwarded to Don Baer at Quality Assured Companies, 235 High Street, Morgantown, WV 26505. Don Baer will store the records and has permission to provide to the employer copies of the drug screen results, audiogram, and radiology review and report.
I understand that completing and passing the Test is required to ensure my safety and the safety of my coworkers. The Test will include lifting, pulling, and the performance of other strenuous activities designed to determine whether I can safely perform the essential functions of the job for which I have applied. I agree that the company and or individual(s) who administer the Test are required to provide me with the protocols and procedures involved in the performance of the Test. If I have any concerns or reservations whatsoever as to whether I can safely perform the Test, I will consult my personal physician prior to attempting the Test.
I also agree that if I feel lightheaded, dizzy, pain, discomfort, and/or any other abnormal symptoms at all during such test, I will immediately discontinue the examination and consult my personal physician prior to proceeding.
I hereby release Mid-Atlantic Coil, LLC, all of its subsidiaries and their respective officers, employees, agents, contractors, and representatives from any and all liability, claims, demands, and damages whatsoever, either in law or equity which may directly or indirectly result from my performance of the Test. To indicate my agreement with the above provisions, I have signed and dated this form below and have provided the following requested information.