HIRING APPLICATION ENGLISH

EMPLOYEE ORIENTATION CHECK-OFF

Please initial the space next to each item as you complete it. Feel free to ask your Employment Representative any questions as they go through the orientation process with you.

I have received, filled out and returned the paperwork to my employer:

Please read and initial:

I have reviewed and understood each topic that I have initialed, and I had all of my questions answered to my satisfaction at this time. At a later time during my employment, I may have additional questions to ask. I will then direct them to my Staff Supervisor.


EMPLOYMENT APPLICATION

APPLICANT INFORMATION

Full Name:

Address:

Reference

Please list two personal references. No immediate family - must be personal or professional only

History Education

Employment pass (4 years)


NOTICE TO APPLICANTS

Employer complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical questionnaire and/or undergo a medical examination. If required, all new employees in the same job category will be subject to the same medical questionnaire and/or undergo a medical examination, and all information will be kept confidential in separate files.

Employer is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, religion, color, sex (including pregnancy and gender identity), sexual orientation, parental status, marital status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or any other non-merit-based factor. We assure you that your opportunity for employment with Employer depends solely upon your qualifications.

STATEMENT OF APPLICANT

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I also authorize employer to release the information contained herein, its findings, and my work history to other firms or persons upon request. I understand and agree that I may be expected to work on a wide variety of job assignments in the Greater Metropolitan area and agree to accept assignment for which I am qualified and available for. I understand that in the event I am hired, failure to report to employer or not showing up to a work site will indicate I have quit.

I understand that neither this document nor any offer of employment from the employer constitutes an employment contract unless a specific document to that effect is executed by the employer and employee in writing.

In the event of employment, I understand that false or misleading information given in any application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I understand that employment is at will of both the employee and employer. This means the employee may quit at any time with or without notice. It also means there is no promise that employment will continue for any reason and it may be terminated by the employer at any time for any reason, with or without notice. Nor is there any promise that your employment will be terminated only under particular circumstances. No one has the authority to make representations inconsistent with this policy. This policy supersedes all written and oral representations that are in any way inconsistent with it.

If employed by the employer, the undersigned agrees and consents to alcohol and/or drug testing whenever there is reasonable suspicion to believe that the undersigned possesses or is under the influence of drugs and/or alcohol and such use or influence may adversely affect the undersigned's job performance, or the safety of the undersigned or co-workers.

Further, I agree, that if I am hired, any employment dispute or grievance whatsoever which may arise during, or as a result of, my employment, or Application for Employment, which cannot be resolved between myself and employer or any of its affiliated companies, shall be resolved or settled by binding arbitration.

FOR COMPANY USE ONLY

SELECT ALL SKILLS


POLICIES AND PROCEDURES CHECKLIST


ABSENT/SICK PROCEDURES

As your employer we understand that at times you will have to be absent from work. In order to ensure that our clients are properly covered, we would like you to follow these procedures:

1. We request at least (2) hours’ notice before your scheduled start time. This will provide us with enough time to obtain a replacement if necessary.

2. You must call the office in which you work with to report your absence. We also recommend that you contact someone personally before the end of the day to confirm that your message was received. Otherwise, you might be considered a no call/no show.

3. Leave a detailed message (speak slowly & clearly) and include the following information: Name (First and last), last four numbers of your social security number, facility you work in, name of your supervisor and the reason why you will be absent or late.

4. Employer will retrieve messages on daily bases and notify supervisors of absences.

5. Please be aware that any absence (excused or unexcused) within your first 2 weeks of starting employment can end your assignment. Your assignments will also be ended for excessive absences. After 3 days, a no call/no show will immediately end your assignment.

6. Please be aware that calling in sick does not excuse excessive absences.


MEAL AND REST PERIODS

1. A thirty (30) minute meal period on each day I work. Such meal period will be provided and made available to me prior to the end of my fifth hour of work on each day.

2. A second (30) minute meal period on each day I work more than ten (10) hours. I can agree to waive this second meal period on those days I work more than ten (10) hours but less than twelve (12). This waiver will need to be in writing.

3. A ten (10) consecutive minute rest period for each four (4) hour work period, or major fraction thereof. The Division of Labor Standards Enforcement (DLSE) considers anything more than two hours to be a "major fraction" of four."

I understand that if Company’s client is not abiding by this policy, I am to immediately report this to my Employer representative, local Branch or Human Resources Department.


DRUG-FREE WORKPLACE POLICY

1. Policy Statement

Employer has a strong commitment to our associates, customers, and the public, to provide a safe and healthy work environment. Employer has established a policy regarding alcohol and substance abuse. It is our policy that necessary measures are taken to assure that the use of alcohol and controlled substances by associates does not endanger the health and safety of those individuals working through our service, our business operations, and our customers. Our goal is to achieve and maintain a workforce free from alcohol and substance abuse. Employer prohibits the use of illegal drugs, alcohol, and other unauthorized items on company property or while on a job assignment. “Possession” includes presence in the body. Company property includes any customer company parking area, storage area, jobsite, and Employer site. Violation of this policy is grounds for disciplinary action up to and including termination of employment. Terminated associates will be ineligible for any further employment through Employer.

The Company explicitly prohibits:

• The use, possession, solicitation for, or sale of narcotics or other illegal drugs, alcohol, or prescription medication without a prescription on Employer or customer premises or while performing an assignment.

• Being impaired or under the influence of legal or illegal drugs or alcohol away from Employer or customer premises, if such impairment or influence adversely affects the employee’s work performance, the safety of the employee or of others, or puts at risk Employer’s reputation.

• Possession, use, solicitation for, or sale of legal or illegal drugs or alcohol away from Employer or customer premises, if such activity or involvement adversely affects the employee’s work performance, the safety of the employee or others, or put at risk Employer’s reputation.

• The presence of any detectable amount of prohibited substances in the employee’s system while at work, while on the premises of Employer or its customers, or while on company business.
“Prohibited substances” include illegal drugs, alcohol, or prescription drugs not taken in accordance with a prescription given to the employee.
Employer/Customer’s property includes any customer company parking area, storage area, jobsite, and Employer’s.

The Company will conduct drug and/or alcohol testing under any of the following circumstances:

Pre-Employment Screening
Potential associates seeking employment with Employer may be required as a condition of employment to submit to and pass a drug test. This policy does not apply to the use of controlled substances within the limits of a valid prescription. If an associate has been placed on assignment pending the results of the drug test, and the associate test positive for illegal drugs, the associate will be removed from the assignment and their employment will be terminated.

Reasonable Suspicion
Employer reserves the right to conduct a drug and alcohol test upon reasonable suspicion that alcohol and/or controlled substances are present, except where or when superseded by federal, state, or local laws. An associate’s consent to such test is required as a condition of becoming and remaining an employee of Employer. A refusal to consent to drug and/or alcohol screening will result in disciplinary action up to and including termination of employment.
Reasonable suspicion includes but is not limited to the following circumstances: evidence of drugs or alcohol on or about the employee’s person or in the employee’s vicinity, unusual conduct on the employee’s part that suggests impairment or influence of drugs or alcohol, negative performance patterns, or excessive and unexplained absenteeism or tardiness.

Work-related Injury/Accident/Incident
Except where superseded by federal or state law or local ordinance, any associate involved in a work-related injury, accident or incident resulting in personal injury to associate or to any other person, or in damage to any property belonging to Employer or to an Employer client/customer, or a third party will be required to submit to a screening test for drugs and/or alcohol use.

Random Testing
Employer may choose to randomly test our working associates for illegal drugs, controlled substances, and/or alcohol except where superseded by state or local law. All random testing will meet any federal or state regulations as required by law. Refusal to submit to a drug screening will be the basis for termination of employment. If any associate’s test is found to be positive, the associate will be subject to disciplinary action up to and including termination of employment. Terminated associates will be ineligible for further employment through Employer.

ACKNOWLEDGMENT OF RECEIPT

I acknowledge that I have received a copy of the foregoing Substance and Alcohol Abuse Policy and that I have read and understand the policies and procedures set forth herein. I understand that it is my responsibility to comply with Employer’s Drug Free Workplace Policy and any revisions made to it.


HARASSMENT, DISCRIMINATION AND RETALIATION PREVENTION POLICY

1. Policy Statement

Employer provides equal employment opportunities to all individuals, regardless of their race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex (including pregnancy, breast feeding and related medical conditions), gender, gender identity, gender expression, age for individuals over forty years of age, military and veteran status, or sexual orientation, as well as any other characteristic protected by applicable federal, state and/or local laws. This is reflected in the company’s practices and policies regarding hiring, assignment, training, promotions, transfers, rates of pay, and other forms of compensation, as well as any other terms, conditions, and privileges of employment.

Employer is firmly committed to the fact that every Associate has the right to be treated with courtesy, dignity and respect, and work in an environment free of discrimination. In keeping with this commitment, Employer maintains a strict policy prohibiting harassment, in any form, including sexual, verbal, physical and visual harassment, coercion, discrimination and/or reprisal. Employer will not tolerate verbal or physical conduct by any employee which harasses, disrupts, or interferes with another’s work performance or which creates an intimidating, offensive or hostile work environment. This policy applies to all associates, management, vendors, and clients. Every person is expected to adhere to a standard of conduct that is respectful to all persons within the work environment. Any person who violates this policy is subject to corrective action, up to an including termination of employment.

Employer and its affiliates strictly prohibit unlawful harassment. This includes harassment on the basis of pregnancy, childbirth or related medical condition, age, marital status, sex, sexual orientation, race, color, ancestry, national origin, citizenship, religion, creed, physical disability, mental disability, medical condition, or any other protected class under applicable law.

Employer’s policy prohibits retaliation against any employee who brings a complaint in the genuine, good faith belief that he or she has been subjected to unlawful harassment or discriminatory treatment, even if the complaint is ultimately not proven by sufficient supporting evidence.

2. Applicability

This policy prohibits unlawful harassment, discrimination, and retaliation in the workplace and applies to all applicants and employees of Employer, including supervisors and managers. Employer prohibits managers, supervisors, and employees from discriminating against or harassing co-workers, applicants, and others, including customers, vendors, suppliers, independent contractors, and others doing business with Employer. In addition, Employer prohibits customers, vendors, suppliers, independent contractors, and others doing business with Employer from discriminating against, harassing, or retaliating against Employer’s employees and/or applicants.

3. Harassment Defined

A. Harassment may consist of offensive verbal, physical, or visual conduct when such conduct. is based on or related to an individual's sex and/or membership in one of the above-described protected classifications, and:

(1) Submission to the offensive conduct is an explicit or implicit term or condition of employment.
(2) Submission to or rejection of the offensive conduct forms the basis for an employment decision affecting the employee; or
(3) The offensive conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creates and intimidating, hostile, or offensive working environment.

B. While all forms of harassment are prohibited, is its Employer’s policy to emphasize that sexual harassment is unlawful an is specifically prohibited. Each supervisor has a responsibility to maintain the workplace free of any form of sexual harassment. No supervisor shall threaten or insinuate, either implicitly or implicitly, that an associate’s refusal to submit to sexual advances will diversely affect the associate’s employment, evaluation, wages, advancement, assigned duties, shifts, or any other condition of employment.

C. Examples of what may constitute prohibited harassment include, but are not limited to, the following:

(1) Verbal or physical abuse/threats, intimidating, swearing, or coercing behavior directed toward (or in the presence of) a client, visitor, associate, or employee.
(2) Kidding or joking about sex or membership in one of the protected classifications.
(3) Hugs, pats, and similar physical contact.
(4) Assault, impeding or blocking movement, or any physical interference with normal work or movement.
(5) Cartoons, posters, and other materials referring to sex or membership in one of the protected classifications.
(6) Threats/bribes intended to induce sexual favors.
(7) Continued suggestions or invitations to social events outside the workplace after being told such suggestions are unwelcome.
(8) Degrading words or offensive terms of a sexual nature based on the individual's membership in one of the protected classifications.
(9) Prolonged staring or leering at a person.
(10) Sexual flirtations, touching, advances, or propositions;
(11)Verbal abuse of a sexual nature, including inappropriate jokes;
(12) Graphic or suggestive comments about an individual’s dress or body;
(13)Sexually degrading words to describe and individual;
(14) The display in the workplace of sexually suggestive objects or pictures, including nude Photographs; and
(15) Similar conduct directed at an individual on the basis of race, color, ancestry, religious creed, handicap or disability, medical condition, age, marital status, sexual orientation, or any other protected classification under applicable law.

4. Retaliation Prohibited

Employer prohibits retaliation against those who report, oppose, or participate in an investigation of alleged violations of this policy. Participating in an investigation of alleged wrongdoing in the workplace includes:

1. Filing a complaint with a federal or state enforcement or administrative agency.
2. Participating in or cooperating with a federal or state enforcement agency that is conducting an investigation of the company regarding alleged unlawful activity.
3. Testifying as a party, witness or accused regarding alleged unlawful activity.
4. Associating with another employee who is engaged in any of these activities.
5. Making or filing an internal complaint with the company regarding alleged unlawful activity.
6. Providing informal notice to the company regarding alleged unlawful activity.

Employer strictly prohibits any adverse action or retaliation against an employee for participating in an investigation of alleged violation of this policy. If an employee feels that he or she is being retaliated against, the employee should immediately report this conduct to Employer’s Human Resources employee. In addition, if an employee observes retaliation by another employee, supervisor, manager, or nonemployee, he or she should immediately report the incident to the individuals above.

Any employee determined to be responsible for violating this policy will be subject to appropriate disciplinary action, up to and including termination. Moreover, any employee, supervisor, or manager who condones or ignores potential violations of this policy will be subject to appropriate disciplinary action, up to and including termination.

5. Internal Reporting Procedure

If you believe that you have been subjected to or witnessed any unlawful harassment, discrimination, or retaliation, you should immediately report such conduct to your supervisor. If you do not feel comfortable reporting harassment or discrimination to your supervisor, you should report the harassment and/or discrimination to Employer’s Human Resources Employee. In addition, if an employee observes harassment or discrimination by another employee, supervisor, manager, or nonemployee, the employee should immediately report the incident to the Human Resources Department.

Employees’ notification to Employer is essential to enforcing this policy. Employees may be assured that they will not be penalized in any way for reporting a harassment or discrimination problem. It is unlawful for employers to retaliate against employees who oppose practices prohibited by the California Fair Employment and Housing Act (“FEHA”), or who file complaints or otherwise participate in an investigation, proceeding, or hearing conducted by the California Department of Fair Employment and Housing (“DFEH”) or the Fair Employment and Housing Commission (“FEHC”). Similarly, Employer prohibits employees form hindering its internal investigations or its internal complaint procedure.

All complaints of unlawful harassment or discrimination that are reported to management or to the Human Resources Department will be investigated as promptly as possible through a fair and thorough investigation by an impartial qualified Employer representative. Employer will conduct its investigation in a manner that provides all parties appropriate due process and reasonable conclusions that are based on the evidence collected, including by documenting, and tracking its investigation. Corrective action will be taken where warranted and based on the documented evidence.

All complaints of unlawful harassment or discrimination will be treated with as much confidentiality as possible, consistent with the need to conduct an adequate investigation.

Supervisors and/or managers who witness harassment, discrimination, or retaliation, or who receive reports of harassment, discrimination, or retaliation, must immediately report such conduct to the Human Resources Department. Failure to do so for supervisors and/or managers may result in disciplinary action.

ACKNOWLEDGMENT OF RECEIPT

I acknowledge that I have received a copy of the foregoing Harassment, Discrimination and Retaliation Prevention Policy and that I have read and understand the policies and procedures set forth herein. I understand that it is my responsibility to comply with Employer’s Harassment, Discrimination, and Retaliation Prevention Policy and any revisions made to it.


CONSENT TO CONTROLLED SUBSTANCE AND/OR ALCOHOL TESTING AND
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION

Upon an offer of employment, you may be asked to consent to a drug test. A negative result is required as a condition of employment.

PLEASE READ THIS DOCUMENT CAREFULLY. BY SIGNING BELOW, YOU ARE CONSENTING TO SUBMIT TO CONTROLLED SUBSTANCE AND/OR ALCOHOL TESTING AND TO AUTHORIZING THE RELEASE OF HEALTH INFORMATION RELATED TO SUCH TESTING.

I, the undersigned employee, have been informed of the bases of employer’s Substance Free Workplace Policy ("Policy"), I have been requested to submit to a controlled substance and/or alcohol test. I understand that if I fail to comply with this request I will not be considered for employment. I also understand that if I receive a "positive" test result or a second "negative dilute" test result, I will not be considered for employment. I understand that some of employer’s Clients have adopted different policies requiring drug and/or alcohol testing. It is my understanding that the Policy and Client policies are implemented for the purpose of providing me with a safer work environment.

I voluntarily consent to be tested for evidence of the presence of controlled substances and/or alcohol in my body through the analysis of my urine, breath and/or blood in consistence with Employer’s and Client’s Policy. I also authorize and consent to the release of the results of such drug and/or alcohol tests to employees, agents and representatives of employer, the Client, and the drug testing companies (including the testing laboratory).

In consideration for my employment and/or my continued employment, I hereby release employer, its Clients, the drug testing laboratory or any facility and their representatives that perform the testing, from any and all liability and responsibility arising out of or relating to the performance of any drug test and/or alcohol test (during my assignment) required by the Policy and Client policy and Client policies and/or any employment related decisions made by employer or its Clients based on any information obtained from a drug/alcohol test.

I hereby authorize employer to transmit, electronically or otherwise any information necessary to perform drug screening including all or part of my social security number where permitted by law.

I have read and understand the above. I acknowledge that a photocopy or facsimile copy of this signed consent and authorization be accepted with the same authority as the original. This release is valid for all private persons and entities, and federal, state, county and local agencies and authorities.


AUTHORIZATION FOR BACKGROUND INVESTIGATION

In connection with my employment and conditional job offer made, promotion or other job change, I understand that employer may obtain an INVESTIGATIVE CONSUMER REPORT (Background Check) that will include information as to my character, general reputation, personal characteristics, and mode of living. This report may reveal information about work habits, including oral assessments of my job performance, experiences, and abilities, along with reasons for termination of past employment.

I authorize and request any present or former employer, school, police department, court records, including those maintained by both public and private organizations, financial institution or other persons having personal knowledge about me to furnish ANY employer Agency and/or its' agents with any and all information in their possession regarding me for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for employment.

I am willing that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from any present or former employer who may provide information based upon this authorization request.

The following is my true and complete legal name, and all information is true and correct to the best of my knowledge:

List all addresses that you have lived at in the past seven (7) years:
(Use additional paper if needed)


JOB DESCRIPTION/PHYSICAL REQUIREMENTS/ESSENTIAL FUNCTIONS

The following are physical requirements pertaining to the jobs for which you are applying. These bona fide physical requirements are essential functions of the job and are in addition to the skills, certifications, years of experience or other qualifications required to perform the job(s) for which you have applied.

Please consider them carefully because you will be required to perform these functions.

You must be able to:

1. Grip, Grasp or Twist using your hands and your hands and wrists regularly during your shift.
2. Be on your feet for long periods (possibly entire shift).
3. Sit or stand long periods during the day.
4. Bend, stoop, and twist regularly during the day.
5. Lift and/or carry up to 50 pounds.
6. Walk extended distances.
7. Operate general office machines.
8. Possibly work around high noise levels.
9. Be exposed to dust and chemical smells.
10. If required, wear personal protective equipment such as, goggles, safety glasses, weight belts, gloves etc.
11. Wear respirator, if required.

Note: All applicants will be given these requirements *

I understand and declare that I can perform all functions listed above.

*Note: If you believe you require accommodation in order to perform the essential functions of any job for which you are applying, please contact Human Resources with your request for accommodation.


SAFETY POLICY

The following safety policies must be followed by all employees on assignment at the Client's worksite:

1. Always adhere to all safety rules, regulations, and instructions at the job site where you are working. Familiarize yourself and comply with all warning signs.

2. No employee will work in any situation or environment where the work may be considered hazardous or dangerous. If you have any doubt that you are not working in a safe environment, immediately consult your supervisor on the job or call the Branch immediately.

3. Do not begin working on a new job assignment without having been trained on the proper safety orientation about your area and about any machinery that you might be expected to use during the course of your assignment.

4. DO NOT operate a piece of equipment or machinery without prior approval from your employer’s representative.

5. All defective machinery or equipment must be reported to your supervisor and employer’s representative.

6. If you are involved in repairing or cleaning machinery, be sure that the main source of power has been turned off and properly tagged to conform with all safety procedures.

7. The job site supervisor is responsible for informing you of any additionally required Personal Protective Equipment or P. P.E. (goggles, gloves, etc.) needed at that workstation.

8. Work behavior that is not professional in conduct, such as horseplay, pranks, or throwing debris at a person or object, is forbidden at all times at the work site.

9. Keep out from under suspended loads.

10. All employees are expected and required to keep their work area clean and orderly.

11. Appropriate clothing and footwear must be worn on the job at all times.

12. Always use the correct tools for the job. If unsure which tool to use, ask the job supervisor. Never use a defective tool.

13. Never walk across, crawl, or reach under or into, any moving chains or conveyors, or in the pathway of operating equipment.

14. Do not perform maintenance or clean up in or around any chains or conveyors, or in the pathway of operating equipment.

15. Never put your hands, feet, or any part of your body into operating machinery.

16. Immediately report all accidents to your supervisor. Remember to identify yourself as an employee. You will have to fill out an Accident Report.

17. Report any on-the-job accident to the employer’s Branch office as soon as possible.

18. Should you incur any injuries while on the job, contact the employer’s Branch office immediately It is your responsibility to contact us as well as to notify the work-site supervisor when and injury occurs.

19. Remember, if you do not know, or if you are in doubt, ask your supervisor and/or call the employer’s Branch office.

20. If you require assistance when lifting an object, please ask a co-worker for assistance. Remember; lift with your legs not your back. Do not under any circumstances lift more than 50 pounds.

Your safety is our concern. We want each and every employee to have a perfect safety record. Failure to comply with these guidelines may result in disciplinary action up to and including suspension and/or termination.

Employer also reserves the right to terminate any employee for complete negligence and disregard for safety. If an employee is injured on-the-job because due to negligence, he/she can be reprimanded and/or terminated from employer, its Client, and any future assignments with employer.

I UNDERSTAND AND WILL COMPLY WITH THE GUIDELINES LISTED ABOVE.

"SAFETY IS OUR TOP PRIORITY!"


SAFETY ORIENTATION QUIZ

Circle One

2. True I False You can use Drugs and Alcohol if your supervisor said it was 0 .K.

3. True I False You should inspect your work area for any unsafe conditions BEFORE you start work AND after all breaks.

4. True I False When used correctly, Personal Protective Equipment will help prevent injuries and can save your life.

5. True I False Safety Glasses only need to be worn when you remember to bring them to work.

6. True I False When repairing any type of equipment, you must ALWAYS be sure to turn it off and unplug the machine BEFORE you begin to repair it.

All applicants must have a minimum of 6 correct answers in order to be considered for employment. If you do not receive a score of 6 or higher, you will be able to re-view the "Safety Orientation" video again and retake the quiz. If at that time you do not pass with a score of 6 or greater, you will not be considered for employment at this time. You will be able to re-apply 3 months from this date.


Personal Physician or Personal Chiropractor
Pre-designation Form

(To be completed by employee)

I, the undersigned employee, in case of an industrial injury or illness, elect to receive medical treatment from my personal physician/personal chiropractor.

I understand that Labor Code Section 4600 defines my "personal physician and surgeon" who has previously directed my medical treatment and who retains my medical records, including my medical history.

I understand that Labor Code Section 4601 defines my "personal chiropractor" as my "regular chiropractor" who has previously directed my treatment and who retains my chiropractor treatment records, including my chiropractic history.

Check One:

or


(To be completed by employer):


If you pre-designate your personal physician, you will be allowed to be treated by this doctor immediately after you are injured. If you fail to pre-designate your personal physician, employer will select a physician for you from the date of injury.


MEDICAL INFORMATION RELEASE


I, the undersigned employee, authorize employer to request and obtain all records regarding any industrial accident/injury or occupational disease involving myself and employer.

This is to include doctor's reports, follow-up reports, nurse's notes, medical bills, test results, etc.

A facsimile or photo static copy of this authorization shall be considered as effective and valid as the original.

This release shall remain in effect until specifically rescinded by me.


CONDITIONAL JOB OFFER MEDICAL QUESTIONNAIRE


All persons are required to furnish health condition information and if necessary, submit to an examination by a company designated physician. This information will be used to determine appropriate job placement. It shall not be used to disqualify an otherwise qualified person who may have a mental or physician disability.

These questions pertain only to the essential functions of the job.

By completing and signing this form, I am verifying that employer has already presented a conditional job offer for me.

Note: All potential employees will be asked these questions.


MUTUAL AGREEMENT TO ARBITRATE CLAIMS

BZ- Resources (“Employer” or “Company”) and (“Employee”) mutually agree that they shall resolve by final and binding arbitration any and all claims or controversies for which a court or other governmental dispute resolution forum otherwise would be authorized by law to grant relief, in any way arising out of, relating to, or associated with Employee’s application for employment with Employer, Employee’s employment with Employer, or the termination of any such employment. This mutual agreement to arbitrate (“Agreement”) includes any claims that Employer may have against Employee, or that Employee may have against Employer (or its owners, directors, officers, managers, employees, or agents), or Employer’s clients (or their owners, directors, officers, managers, employees, or agents). The Parties agree that their mutual agreement to arbitrate any Arbitrable Dispute (as defined below), together with Employee’s employment by Employer on and after the date Employee signs this Agreement, shall constitute sufficient consideration by each Party for the promises made herein. This Agreement shall be effective on the date it is signed by Employee.

All affiliated entities, owners, shareholders, directors, members, officers, employees, and agents and clients of Employer are intended to be express beneficiaries of this Agreement. Any claim asserted against any such beneficiary arising out of, relating to, or associated with Employee’s application for employment with Employer, Employee’s employment with Employer, or termination of Employee’s employment with Employer is governed by this Agreement.

Employer and Employee each agree that arbitration, as provided for in this Agreement, shall be the exclusive forum for the resolution of any covered dispute between the parties. In agreeing I to arbitration, both Employer and Employee explicitly waive their respective rights to trial by JurI y. This mutual agreement to arbitrate claims is governed by and enforceable under the Federal Arbitration Act, 9 U.S.C. § 1 et seq. (the “FAA”), but if the FAA is held not to apply to this Agreement, or to any portion of it, for any reason, this mutual agreement to arbitrate claims shall, to that extent, be governed by and enforceable under the California Arbitration Act, Cal. Code Civ. Proc. § 1280 et seq. This Agreement does not create and shall not be construed to create any substantive rights that Employee or Employer would not have in a judicial or administrative action in the absence of this Agreement. Employer and Employee agree that any claim, dispute, and/or controversy shall be submitted to and determined exclusively by binding arbitration under the FAA, in conformity with the procedures of the California Arbitration Act, including all of the Act’s other mandatory and permissive rights to discovery.

The claims covered by this Agreement include, but are not limited to, all past, present, and future claims, disputes, or controversies of any nature, in any way arising out of, related to, or associated with Employee’s employment with Employer, for which a court or government agency is or may be authorized by law to grant relief, whether such claim is asserted by Employee against Employer, or by Employer against Employee (collectively, “Arbitrable Disputes”). Without limiting the foregoing, the term “Arbitrable Disputes” includes, but is not limited to: (1) any claims for breach of express or implied contract; claims for breach of any fiduciary duty or other duty owed to Employee by Employer or to Employer by Employee; torts; discrimination or harassment based on race or color, sex (including gender identity or gender expression), pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, religion, national origin, ancestry, age, marital status, domestic partner status, physical disability, mental disability, medical condition, genetic information, sexual orientation, veteran status, or any other status protected under present or subsequently enacted law; violation of public policy; unpaid wages, bonuses, expenses or penalties; any claims relating to benefits, hours of work or working conditions; and any other claims for violation of the United States or any State constitution, or any federal, state, or local statute, ordinance or regulation (as originally enacted and as hereafter amended), including but not limited to claims under Title VII of the Civil Rights Act of 1964, the Fair Labor Standards Act, the Employee Retirement Income Security Act, the Consolidated Omnibus Budget Reconciliation Act, the Family and Medical Leave Act, the Age Discrimination in Employment Act, the California Fair Employment and Housing Act, the California Family Rights Act, the California Labor Code, the California Civil Code, or the California Industrial Welfare Commission Wage Orders; (2) any claims relating to the termination of Employee’s employment, any demotion or disciplinary action, any decision not to promote Employee, or any other adverse employment action taken by Employer against Employee; and (3) any employment-related claims by Employer against Employee.

This Agreement does not limit Employee’s right to file an administrative charge with the National Labor Relations Board (“NLRB”), the Equal Employment Opportunity Commission (“EEOC”), or any state agency charged with enforcement of fair employment practice laws, but Employee agrees to arbitrate under this Agreement all issues raised by such a claim, including monetary or other damages. This Agreement also does not apply to or cover: (1) claims for workers’ compensation benefits; (2) claims for unemployment compensation benefits; (3) claims for state disability or paid family leave benefits. (4) claims based upon an employee pension or benefit plan the terms of which contain an arbitration or other non-judicial dispute resolution procedure, in which case the provisions of such plan shall apply, or; (5) any claim which is not subject to mandatory arbitration under applicable law.

All claims brought under this Agreement shall be brought in the individual capacity of Employee or Employer. This Agreement shall not be construed to allow or permit the consolidation or joinder of other claims or controversies involving any other employees or permit such claims or controversies to proceed as a class action, collective action, private attorney general action or any similar representative action. No arbitrator shall have the authority under this Agreement to order any such class or representative action. By signing this Agreement, Employee waives any substantive or procedural rights that he or she may have to bring an action on a class, collective, private attorney general, representative or other similar basis. However, this Agreement will not prevent Employee from participating in class actions lawsuits which may have been filed against Employer and are pending at the time this Agreement is executed.

A party with an Arbitrable Dispute must initiate the dispute resolution process by submitting a written demand for arbitration under this Agreement within the applicable statute of limitations period.

Any arbitration shall be conducted before a single arbitrator. The parties shall attempt in good faith to select as Arbitrator any retired judge or justice, or any professional arbitrator mutually agreeable to both parties. If the parties are unable to mutually agree on an arbitrator, the Arbitrator shall be selected from a listing of retired judges with Judicate West.

Employer will pay any arbitration filing fee, together with the Arbitrator’s fees and all other arbitration expenses. Each party shall bear that party’s own costs of legal representation; provided, however, if any party prevails on a claim entitling the prevailing party to attorneys’ fees and/or costs pursuant to any applicable contract or statute, the Arbitrator may award reasonable fees and/or costs to the prevailing party in accordance with such claim.

The arbitration shall take place in Orange County, California. In arbitration, the parties will have. the right to conduct civil discovery, including, but not limited to written discovery and depositions, and the right to bring motions, as provided by the California Code of Civil Procedure, subject to the Arbitrator’s right to limit or to expand the scope of discovery for good cause.

Within thirty (30) calendar days of the close of the arbitration hearing, any party will have the right to prepare, serve and file with the Arbitrator a brief. The Arbitrator shall issue a written decision that reveals the essential findings and conclusions on which the decision is based, and subject to the terms and provisions of this Agreement, the Arbitrator’s decision shall be subject to such judicial review as is provided by law.

Nothing contained in this Agreement shall be deemed to alter or modify Employer’s policy of at-will employment. Employment at Employer is at-will and can be terminated by either an employee or by Employer at any time, for any reason or no reason, on notice to the other party. This Agreement shall survive any separation of Employee’s employment. This Agreement may not be altered or modified other than by an individual written agreement specifically referencing such alteration or modification, signed both by Employee and by Employer’s highest-ranking executive officer.

This is the complete agreement of the parties on the subjects of arbitration of claims and waiver of trial by jury. This Agreement supersedes any prior or contemporaneous oral, written, or implied understanding, negotiation, or discussion on the subject. If any provision of this Agreement is held invalid, void, or unenforceable by a court having jurisdiction, the remainder of this Agreement shall remain in full force and effect; provided, however, that if the provision herein for the waiver of class, collective or representative action relief is held unenforceable, the parties shall be deemed to have made no agreement to conduct any arbitration on a class, collective or representative action basis.

If Employee’s agreement to waive the right to bring an action under the California Private Attorneys General Act of 2004 is declared void or unenforceable and Employee brings an action that includes claims subject to this Agreement and claims under the California Private Attorneys General Act of 2004, both Employer and Employee agree to stay any claims under the California Private Attorneys General Act of 2004 until the claims subject to this Agreement are fully arbitrated.


EMPLOYEE’S CERTIFICATION OF UNDERSTANDING OF AGREEMENT

EMPLOYEE’S SIGNATURE BELOW CONFIRMS THAT EMPLOYEE HAS READ, UNDERSTANDS, AND AGREES TO BE LEGALLY BOUND BY, ALL OF THE TERMS OF THIS AGREEMENT.

EMPLOYEE SHALL NOT SIGN UNTIL EMPLOYEE HAS READ AND UNDERSTANDS THE ENTIRE AGREEMENT. AFTER SIGNING THIS AGREEMENT, EMPLOYEE HAS NO RIGHT TO PURSUE CLAIMS AGAINST THE COMPANY IN COURT AND BEFORE A JURY, BUT ONLY THROUGH THE ARBITRATION PROCESS.