On occasions some customers will require a drug screening. This consent form will only be applicable under customer's request, or reasonable suspicion of being under the influence of drugs or alcohol while on duty. In the case of being under a prescription this should be notified to your immediate supervisor if it impairs your ability to operate a motor vehicle or perform your job duties in a safe matter to you and other employees. I hereby agree to submit to a drug or alcohol test by furnishing a sample of my urine, breath, and/or blood for analysis. I have been fully informed of the reason for this test and I understand what I am being tested for and the procedure involved. I am fully aware that the results of this test will be forwarded on to my potential employer or current employer and will become part of my record. I understand that if at any time I refuse to submit to a drug or alcohol test, or if I otherwise fail to cooperate with the testing procedures, my application for employment may be immediately withdrawn from consideration or I may be subject to immediate termination.

It is the responsibility of each employee to conduct all tasks in a safe and efficient manner complying with all local, state and federal safety and health regulations and program standards, and with any special safety concerns for use in a particular area or with a client.

Although most safety regulations are consistent throughout each department and program, each employee has the responsibility to identify and familiarize her/himself with the emergency plan for his/her working area. Each facility shall have posted an emergency plan detailing procedures in handling emergencies such as fire weather-related events and medical crises.

It is the responsibility of the employee to complete an Accident and Incident Report for each safety and health infraction that occurs by an employee or that the employee witnesses. Failure to report such an infraction may result in employee disciplinary action, up to and including termination.

I understand Superior Staffing Corp 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, Superior Staffing Corp 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 Superior Staffing Corp immediately, who will then coordinate with the client and myself, ensuring proper procedures for treatment and reporting of the accident.

I understand that the duties in job assignments vary by position and/or Superior Staffing Corp clients. I agree to notify Superior Staffing Corp immediately if I am requested to perform work which I am unable to perform due to a disability, so that we may discuss the options for reasonable accommodations.

It is understood that overtime (OT) will be paid when working for one Customer over 40 hours in a one week pay period. It is understood, there may be an occasion where an employee will work more than 40 hours with two or more Customers. On these occasions, overtime will NOT be paid.

By signing below, the employee acknowledges they read and understand the above disclosure, and agree to the terms above.