AUTHORIZATION OF CONSENT
I hereby declare that all statements contained in this application are true and correct and I understand that false, misleading or inaccurate information in this application will be the basis for withdrawal of any employment offer of if employed, may result in dismissal.
I hereby authorize COMPANY to request and obtain all records regarding any industrial accident or occupational disease involving myself orCOMPANY. This is to include doctor’s reports, follow up reports, nurses notes, medical bills, test results, etc. A facsimile or Photocopy of this authorization shall be considered as effective and valid as the original. This release will remain in effect until specifically rescinded by me.
In connection with my employment/application for employment with All Tex Staffing & Personnel, Inc. (“COMPANY”) and its clients, I hereby authorize all persons, schools, corporations, credit bureaus, courts, law enforcement agencies, health care providers, armed forces, employment commissions and all government agencies to request and release any and all information without restriction or qualification. I am aware that I recourse and release the requested parties from liability for complying with this request/release. I hereby authorize COMPANY to request and obtain all records regarding any industrial accident or occupational disease involving myself or COMPANY. This is to include doctor’s reports, follow up reports, nurses notes, medical bills, test results, etc. I acknowledge that a facsimile or Photocopy of this authorization shall be considered as effective and valid as the original. All results will be proprietary and confidential, and will not be provided to any parties other than the company or its legal representatives. This release will remain in effect until specifically rescinded by me.
I understand COMPANY and its clients are committed to providing a DRUG- and ALCOHOL-FREE WORK PLACE. If hired, I will be provided with a copy of COMPANY’s drug & alcohol abuse and screening policy. I understand COMPANY will require a drug and/or alcohol screen upon application for employment, randomly and whenever an on-the-job accident or injury is reported. I further understand that the screening may be required of only the person involved or required of all employees within the area of occurrence. My signature to this application acknowledges my consent and release to be personally screened by COMPANY and/or their designated medical/screening service. I further understand and agree to COMPANY periodically testing its employees to insure personnel do not report to work with alcohol, illegal drugs and/or legal drugs illegally taken in their systems. I understand that failure to submit to any drug/alcohol screening will be grounds for termination. I agree to hold all parties harmless, meaning I will not sue or hold them responsible for any alleged harm to me, interfering with my obtaining a job, or continuing employment by not submitting to the screen(s), or as a result of the report of the screening, including possible clerical or laboratory errors. I acknowledge that this authorization and consent has been explained to me in a language I understand and I have been advised of the answers to any question(s) I have about these policies. I understand that this agreement is a legal and binding document because COMPANY is sending me for the examination and will incur expenses for the same.
The possession, use, purchase, sale or distribution of any firearm or other weapon is strictly prohibited on the premises of COMPANY, a Client Company, and all other worksite locations or while furthering company business. With probable cause, all employees are subject to search of personal items, including but not limited to: purses, brief cases, lunch boxes, and desks. The failure to permit or to cooperate with a search will constitute an immediate resignation of employment. Your signature below acknowledges your understanding and agreement with COMPANY’s ZERO TOLERANCE Weapons policy and that you will be immediately terminated for violation of this policy.
I understand that COMPANY and its clients have agreed that COMPANY will provide workers’ compensation insurance coverage for its employees. In the event of an injury in the workplace, I agree that my sole remedy lies in coverage under COMPANY’s workers’ compensation insurance policy. I agree that any recovery which I might receive as a result of an injury during the course & scope of my employment will be limited to the extent of COMPANY’S insurance in force at the time of the injury.
If employed by COMPANY, I agree to conform to the rules and regulations of COMPANY and its client companies. I further understand that that this agreement in no way limits my rights or COMPANY’S rights to terminate employment, with or without cause or notice, at any time, at the discretion of COMPANY or myself. I further understand that only a duly authorized manager or representative of COMPANY, including COMPANY owner, has authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any assurance or promise of continued employment.
This authorization & consent has been explained to me in a language I understand and I have been advised of answers to any questions I have about these policies. I understand that this agreement is a legal and binding document because COMPANY is sending me or this application for examination and I may incur expenses for the same.