Applicant Acknowledgement
As allowable by union agreements, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I agree to undergo a pre-employment drug/alcohol test. I understand that if I refuse to consent to testing, fail to provide a urine sample when requested, provide a false or tampered urine sample or fail to successfully complete the drug/alcohol test, I will not be hired in accordance with Berglund’s policy.
I understand that my employment application and any other company documents are not a contract of employment and that any individual who is hired may voluntarily leave or be terminated at any time, with or without cause.
I understand that as directed by company policy and consistent with the job requirements, you may be requesting information from public and private sources about my: injuries, driving record, court record, education, credentials and references.
Medical and workers’ compensation information will only be requested in compliance with the Federal American’s with Disabilities Act (ADA) and/or any other applicable state laws.
I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contracted by Berglund Construction Company or its agency, to furnish the information described above.
I hereby authorize release of information from my Department of Transportation regulated drug and alcohol testing records by my previous employer to Berglund Construction. This release is in accordance with DOT Regulation 49CFR Part 40, Section 40.25. I understand that information to be released by my previous employer, is limited to the following DOT-regulated items, alcohol tests with a result of 0.04 or higher, verified positive drug tests, refusals to be tested, other violations of DOT agency drug and alcohol testing regulations, information obtained from previous employers of a drug and alcohol rule violation and any documentation of completion of the return-to-duty process following a rule violation.
This information is confidential and will not be used for any other purposes. I hereby release the employer and agents and all persons, agencies and entities providing information or reports about me from any and all liability arising out of the requests for a release of any of the above-mentioned information or reports.
I certify that all statements made by me on this application are true and correct to the best of my knowledge and belief. I understand that any false, inaccurate or omitted material statements could, in fact, be cause for rejection of my application or termination of my employment at any time.
I have read, understand and, by my initials and date of birth, consent to these statements.