Workplace Background Check Policy
I hereby give my informed consent to the designated Road Dog Industrial Representative and/or its partner companies to conduct a background check. I understand that refusal to submit to a background check may disqualify me from consideration
for employment or, if employed, subject me to immediate disciplinary action up to and including immediate discharge.
I certify the the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statement on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any information concerning my previous employment and any pertinent information they may have, personal or otherwise,
and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, unless it is in writing
and signed by an authorized company representative.
I also authorize Road Dog Industrial to release the information contained herein and its findings and work history of my employment to other firms or persons upon request. I also understand and agree that I may be expected to work on a
wide variety of job assignments and agree to accept assignments for which I am qualified as they become availiable. I also understand my failure to report to Road Dog Industrial for work will indicate I have quit. I also agree to submit
to a drug screen upon request or as specified in Road Dog Industrial’s substance abuse policy.
Download Employee Handbook PDF
By signing this I certify that I have read and fully understand Road Dog Industrial’s Employee Handbook and Road Dog Industrial Safety Manual.
Drug Screen Authorization and Consent
I hereby authorize and give full permission to have Road Dog Industrial and/or their medical company physician send a specimen of my urine and/or blood to a laboratory for screening test using Substance Abuse & Mental Health Services Administration
www.samhsa.gov) standards for the presence of illegal drugs, alcohol, or prescription medication taken without a prescription.
I will hold all parties concerned harmless, meaning I will not sue nor hold responsible for any alleged harm to me of interfering with my obtaining a job or continuing employment due to not submitting to the tests or as a result of the report of the tests.
This includes, but not limited to, possible clerical or laboratory error.
This policy and authorization has been explained to me in a language I understand and told if I have any questions they will be answered about the test. I understand this is a legal and binding document, which is binding because Road Dog Industrial is
sending me for the examinations and paying for it.
I UNDERSTAND ROAD DOG INDUSTRIAL WILL REQUIRE A DRUG SRCEEN TEST WHENEVER AN ON THE JOB ACCIDENT OR INJURY IS REPORTED IN ACCORDANCE WITH THIS STAFFING COMPANY POLICY AND THIS AUTHORIZATION AND CONSENT. MY REFUSAL TO SUBMIT TO DRUG TESTING
WILL BE GROUNDS FOR TERMINATION.
Substance Abuse Policy
It is the purpose of Road Dog Industrial to help provide a drug free environment for our clients and our employees. With this goal and because of the serious drug abuse problem in today's workplace, we are establishing the following policy
for existing and future employees of Road Dog Industrial:
Road Dog Industrial explicitly prohibits:
The use, possession, solicitation for or sale of narcotics or other illegal drugs, alcohol, or prescription medication that adversely affects the employee's work performance, his or her own or other’s safety at the workplace, or the employer’s
Road Dog Industrial may drug test using Substance Abuse & Mental Health Services Administration (S.A.M.H.S.A.) (
Employees of Road Dog Industrial who refuse to submit to drug testing, test positive, or admit to substance abuse will be subject to termination.
The results of all drug testing will be treated confidentially, and for no purpose other than for Road Dog Industrial to make employment related decisions.
Policies and Procedures Checklist
I understand Road Dog Industrial takes their responsibility as my employer very seriously, and that they have gone to great lengths to provide a safe work environment. If I am injured on the job, Road Dog Industrial will deal promptly
with legitimate claims and has workers compensation insurance that will pay medical expenses and wages. I also understand that Road Dog Industrial has extensive experience investigating claims and will fight fraudulent claims with
all available resources.
If I sustain an injury on the job, I will inform the client and Road Dog Industrial within 24 hours, who will coordinate with the client and myself the proper procedures for treatment and reporting of the accident.
Road Dog Industrial has a strict “Substance Abuse Policy", and I have signed a consent form to submit to drug testing. I understand that my failure to comply with this agreement will be grounds for my immediate termination.
I understand and will comply with Road Dog Industrial safety rules and regulations and hazardous communication program.
I understand that I must come prepared with all required tools of the trade and any needed PPE.
I am telephone accessible, and I have reliable transportation.
I understand that I am an employee of Road Dog Industrial and only Road Dog Industrial or I can terminate my employment. When an assignments ends I must report to Road Dog Industrial for my next job assignment.
I understand that I am expected to complete any job assignment I accept. I understand that if I do not complete or promptly notify of my inability to complete the assignment, or if I do not report for my assignment then Road Dog Industrial
may assume that I have voluntarily quit.
If for some unexpected reason, such as an emergency or illness, I cannot make it to work or will be late, I will contact Road Dog Industrial and my on-site foreman as soon as possible. Road Dog Industrial may adjust my hourly wage
to the Federal Minimum Wage, if I leave the assignment within the first week without written notice.
I understand Road Dog Industrial requirements for receiving information, documenting hours worked, the method of providing the information, and the time frame for me to provide this information. I understand Road Dog Industrial will
not recognize or pay for any hours worked by an employee without proper documentation verifying hours worked.
I have read and fully understand the above statements regarding Road Dog Industrial policies and procedures and agree to the same. I understand that failure to comply with these policies and procedures could lead to my termination and
may jeopardize my insurance beneﬁts.
General Safety Rules
Road Dog Industrial has developed these safety rules patterned after the Federal OSHA requirements. Read and become familiar with these rules, and other safety rules that apply to your job.
Report an injury to your employer/supervisor within 24 hours.
Report any observed unsafe condition to your employer/supervisor.
Horseplay is prohibited at all times.
The drinking of alcoholic beverages is not permitted on the job. Any employee discovered under the inﬂuence of alcohol or drugs will not be permitted to work.
If you do not have current First Aid Training, do not move or treat an injured person unless there is an immediate peril, such as profuse bleeding or stoppage of breathing.
Appropriate clothing and footwear must be worn on the job at all times.
Where there exists the hazard of falling objects, an approved hard hat must be worn.
You should not perform any task unless you are trained to do so and are aware of the hazards associated with the tasks.
You may be assigned certain personal protective safety equipment. This equipment should be available for use on the job, be maintained in good condition, and worn when required.
Learn safe work practices. When in doubt about performing a task safely, contact your supervisor for instruction and training.
The riding of a hoist hook, or on other equipment not designed for such purposes, is prohibited at all times.
Never remove or by-pass safety devices.
Do not approach operating machinery from the blind side; let the operator see you.
Learn where ﬁre extinguishers and first aid kits are located.
Maintain a general condition of good housekeeping in all work areas at all times.
Obey all traffic regulations when operating vehicles on public highways.
When operating or riding in company vehicles or using your personal vehicle for business purposes, the vehicle's seatbelt shall be worn.
Be alert to hazards that could affect you and your co-employees.
Obey safety signs and tags.
Always perform your assigned task in a safe and proper manner; do not take shortcuts. The taking of shortcuts and the ignoring of established safety rules is a leading cause of employee injury.
I certify that l have read and understand and will abide by the above listed safety rules. Failure to do so may be grounds for termination and may disqualify my insurance benefits. By signing this form, I agree to the following: I am responsible
for the equipment or property issued to me including Hard Hats 30.00 and Lanyards (550.00); I will use it/them in the manner intended; I will be responsible for any damage done (excluding normal wear & tear); upon separation from
the Company, I will return the item(s) issued to me in proper working order (excluding normal wear & tear); I will replace any items issued to me that are damaged or lost at my expense; I authorize a payroll deduction to cover
the replacement cost of any item issued to me that is not returned for whatever reason, or is not returned in good working order.
We are equal opportunity employer and drug-free workplace.
You agree your electronic signature is the legal equivalent of your manual signature on this Application.
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Acknowledgement of Benefit Offerings
On the first day of the month following 59 days from date of hire, employees will be eligible for benefits.
You must either ENROLL or WAIVE coverage within 30 days from your date of hire per the following options:
(1) Complete the attached 2018 Enrollment/Waiver Form and submit to Human Resources
www.psg.tsebenefits.com to complete online enrollment or waive.
In the event your Enrollment Form is not returned by the enrollment deadline, it will be assumed that your Benefit Offerings are being waived. You will not be able to reapply for Benefits until the next open enrollment period, unless you have a qualified change in family status. A qualified change in family status as defined by the IRS allow benefit changes outside of the annual open enrollment period providing the change is consistent with the Qualifying Event. The following are a few QE examples: marriage, divorce, birth, adoption, loss of other health coverage or a change in your dependent’s eligibility status.
My signature below acknowledges the following:
(1) I have been offered affordable and minimum essential medical coverage under the Affordable Care Act (ACA)
(2) I understand that if I do not submit a completed enrollment form by the enrollment deadline as listed above, I am declining coverage for the current plan year.
(3) Enrollment for future plan years will need to be completed and submitted each year as enrollment is not automatic. If at that time, I want to participate in the plan, it is my responsibility to contact Human Resources.