| Legal Statement
Agreement |
xxxx APPLICATION FOR
EMPLOYMENT
Xxxx is an Equal
Opportunity Employer. Federal, state and local
laws prohibit discrimination because of race,
color, sex, or sexual orientation, age, religion,
creed, natural origin, disability, marital status,
status as a disabled veteran or Veteran of the
Vietnam era, or any other characteristics
protected by federal, state or local
laws.
PERSONAL
DATA
Providing non-job related information
which is not requested will disqualify your
application for employment consideration. Note:
Where dates and other personal identifiers are
requested the information is required and used for
information verification processing
only.
BACKGROUND EXAMINATION
NOTICE & AUTHORIZATION/FAIR CREDIT REPORTING
ACT AUTHORIZATION
In connection with
Xxxx's consideration of me for employment,
continued employment, promotion, or reassignment,
I understand that Xxxx may obtain a consumer
report and/or an investigative consumer report.
Xxxx may also conduct its own investigative
inquiries into my background that may include
obtaining such things as criminal, driving,
personal reference(s), and job reference(s)
pertaining to me. These inquiries will be
conducted to provide Xxxx with information
regarding my character , general reputation,
personal characteristics, mode of living, work
records, salary history, and characteristics,
skills and abilities, education and training,
employment experience, past job performance,
reasons for termination of previous employment and
other pertinent information.
I
understand that for this purpose Xxxx or persons
acting on its behalf will be requesting
information from various federal, state, and local
governmental agencies, previous employers and
their employees, personal acquaintances of mine,
and other appropriate sources of information that
maintain records or possess knowledge about my
education, employment, criminal, driving and other
relevant activities, experiences and records,
including, but not limited to, my character,
general reputation, personal characteristics, and
mode of living.
I authorize, without
reservation, any person or entity contacted by
Xxxx or anyone acting on its behalf, to furnish
the above-stated information, and I release any
such person or entity from any and all liability
for furnishing such information. I also release
Xxxx from any and all liability for conducting
such an investigation.
I authorize
Xxxx to disclose my Social Security number in
order to obtain necessary information. I
understand that if I refuse to execute this
authorization, Xxxx may refuse to grant employment
based on this refusal. A copy of this executed
authorization shall be valid as the
original.
METHOD FOR
RESOLVING EMPLOYMENT DISPUTES
As a
condition of my employment with Xxxx, I agree to
raise all employment-related disputes and claims
by the method proscribed in the “Raising Concerns
Policy”. If this method is unsuccessful, I agree
to address the claim through the Employee Dispute
Resolution (EDR) program, a mediation program
created by Xxxx. I understand that these steps are
the exclusive means for first attempting to
resolve employment disputes.
I
understand that this program does not limit or
eliminate my legal rights nor does it prohibit me
from filing a federal, state, or agency claim or
lawsuit before mediation. If I pursue agency or
court proceedings before completion of EDR, Xxxx
will advise the agency or court of the EDR program
and file a motion to dismiss or stay. I am
ineligible to participate in the EDR program if:
my position is eliminated through a reduction in
force or if my termination falls under the company
Severance Payment Plan; I am a retiree or employee
who has signed a general release; or I am on a
leave of absence (I may pursue EDR when I return
to “active
status”).
EMPLOYMENT
RELATIONSHIP
I understand that this employment
application and any other documents, including
policies, handbooks, guidelines, practices,
benefits or manuals, are not intended to create
any contractual obligation which in any way
conflicts with Xxxx's policy that the employment
relationship between the Company and each employee
is at-will and can be terminated, with or without
cause, and with or without notice at any time, at
the option of either the Company or the employee.
I further understand that any oral or written
statements to the contrary are expressly disavowed
and should not and can not be relied upon.
Exceptions to this policy may only be made with
the prior written approval of the Senior Human
Resources Executive.
Xxxx reserves
the right to make changes to its policies,
practices, guidelines, handbooks, manuals,
benefits or employee complement when, in its sole
judgment, it deems necessary or useful to do
so.
In the event the Company should
wish to use my photograph in connection with
publicity, sales promotion, or other Company
purposes, I hereby give my permission for such use
without any further
consideration.
CONSENT TO
RELEASE OF MEDICAL INFORMATON
I hereby
consent to the disclosure of information
concerning my ability to safely perform my duties
of employment, or for continued employment, by
Xxxx, including information concerning the
presence of alcohol and/or illegal drugs in
blood/urine samples taken from me during screening
testing procedures in conformity with all federal,
state and local laws.
I authorize the
third party designate of Xxxx to test samples
taken from me and disclose the results to the
Senior Human Resources Executive or his/her
designee, and to report the results consistent
with the Xxxx safety policy and its program for
maintaining a Drug/Substance Abuse Free
workplace.
The consent to disclose medical
information was given freely, without reservation,
and for the purpose set out
above.
IMMIGRATION REFORM
AND CONTROL ACT
As a condition of
employment with Xxxx, successful applicants must
provide, within three days after beginning
employment documentation to prove identity and
proper authorization to work in the United States.
Specific instructions will be given prior to your
first day of employment regarding the documents
required.
FREEDOM FROM
ALCOHOL & SUBSTANCE ABUSE
Xxxx
Inc. (Xxxx) strives to maintain an
environment that is free of drug, alcohol and
substance abuse to help assure employees of a safe
and productive workplace. Substance abuse can
endanger not only the user's safety, but also that
of employees and members of the community.
Therefore, Xxxx will not employ any applicant who
refuses to take, or has positive results from, the
pre-employment illegal substance test. An
applicant must submit to the illegal substance
test within 48 hours of receipt of the illegal
substance test
notification.
DEFINITIONS
A.
Under the Influence
"Under the Influence" means
the employee is affected by a drug or alcohol or
the combination of a drug and alcohol in any
detectable manner. The symptoms of "under the
influence" are not confined to those consistent
with misbehavior, nor the obvious impairment of
physical or mental ability, such as slurred speech
or difficulty in maintaining balance. A
determination of "under the influence" can be
established by a professional opinion, a
scientifically valid test, and, in some cases such
as alcohol, by layperson's opinion.
B.
Legal Drug
"Legal Drug" includes medically
authorized prescription drugs and over-the-counter
drugs which have been legally obtained and are
being used for the purpose and in the dosage for
which they were prescribed.
C. Illegal
Drug
"Illegal Drug" means any drug which is not
legally obtainable or one which can be legally
obtained but has not been, and prescribed drugs,
legally obtained which are not being used for
prescribed purposes.
D. Hemp
Oil
Hemp Oil and/or hemp products are widely
available on today’s market. These products
contain varying levels of THC and as a result,
they can produce a positive urinalysis which is
not acceptable. Xxxx strictly prohibits the use of
such products and will not disregard a positive
test result due to such use. Employees and
candidates for employment must abstain from using
hemp products, including hemp oil, which contain
THC.
GUIDELINES -
PROSPECTIVE EMPLOYEES
1. All candidates for
employment will be advised of Xxxx's Freedom from
Alcohol & Substance Abuse policy, procedures
and programs.
2. Prospective employees
will be asked to complete a Consent to Release of
Medical Information form.
3. Tests will
be conducted by an independent laboratory. Upon
arrival at the testing location, the prospective
employee will be asked to present proof of
identity. Prospective employees who fail the test
and test confirmation will not be considered for
employment for a period of at least six (6) months
and then must be retested.
4.
Prospective employees who refuse to submit for
testing will not be considered further. They may
re-apply after (6) months, but then must comply
with the provisions of our Policy.
5. A
Prospective employee may appeal the test results
within (5) business days of receiving the results,
by submitting a written appeal to the Senior Human
Resources Executive, Xxxx Inc., One
Xxxx Drive, Park Ridge, NJ 07656-8003. Whenever
possible, the prospective employee will receive
our decision within ten (10) business
days.
6. Contract employees, temporary
employees, interns, consultants, and school
cooperative employees must also submit to the
above outlined procedures before they conduct
business for the
company
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I
certify that the information provided in this
application is true and complete to the best of my
knowledge and understand that falsification or
omission of any information is grounds for
rejection of my application or termination of my
employment, if you employ
me.
CHOOSE "I AGREE" TO THE
ABOVE TERMS AND CONDITIONS TO CONTINUE BEING
CONSIDERED FOR EMPLOYMENT WITH
xxxx.
You will next be asked to
sign-in using the username and password created
during your original submission. Once signed in,
select the Employment Application to finish the
application process.
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