(713) 589-6496 info@desss.com

EMPLOYMENT APPLICATION












EDUCATION






PREVIOUS EMPLOYMENT






SAFETY POLICY

All employees have a safety responsibility to themselves, their family, fellow workers, the community, the client and to LaneStaffing While accepting this responsibility; they are expected to observe safety rules and regulations as well as the instructions relating to safe performance. A safe and sound operation is reached only when all employees are conscious of and alert to their safety responsibilities. Complying with all company policies, including safety is a condition of continued employment with this company. Employees shall be responsible and accountable for the following:

  • 1. Know, understand and comply with the safety policy, rules and procedures;
  • 2. Attend and participate in all safety meetings;
  • 3. Participate in safety inspections and audits;
  • 4. Report and correct unsafe acts and conditions;
  • 5. Properly use and care for supplies and equipment;
  • 6. Maintain good housekeeping at all times;
  • 7. Assist in the development of safety rules, regulations and safe work practices;
  • 8. Report accidents and injuries to supervision immediately after an incident.

DISCLOSURE AUTHORIZATION


(Authorization expires one year from this date)

In connection with your application for employment with LaneStaffing, we may obtain a consumer/investigative report for you as part of the process of considering your eligibility for assignment or placement with specific clients. In the event the information from the report(s) in used in making an adverse decision regarding your eligibility for assignment or placement , we will notify you and provide you with a written description of your legal rights.

By signing below, I hereby authorize LaneStaffing to obtain a consumer/investigative report about me in order to consider me for assignment or placement through LaneStaffing.








If applying for positions requiring you to drive on the job, please completed the following :

SUBSTANCE ABUSE POLICY

It is the purpose of LaneStaffing, to help provide a drug free environment for our clients and employees. With this goal and because of the serious drug problem in today's workplace, we have established the following policy for existing and future employees of LaneStaffing. LaneStaffing explicitly prohibits: The use, possession, solicitation for or sale of narcotics or other illegal drugs, alcohol, inhalants, or prescription medication without a prescription on the company's or customers premises or while performing an assignment. Being impaired or under the influence of illegal drugs, alcohol, or inhalants off the company premises that adversely affects the employee's work performance, their own or others safety at the workplace, or the employer's reputation. We expressly prohibit possession, use, solicitation of or sale of illegal drugs, alcohol, or inhalants off the company's premises that adversely affect the employee's work performance, their own or others safety at the workplace, or the employer's reputation LaneStaffing, will drug test by two (2) methods: Randomly: A random selection of some employees will be performed unannounced. For Cause: When it is the company's belief that a drug problem exists; such as evidence of drugs, accidents, injuries in the workplace, fights, or other incidents, behavioral symptoms of drug abuse, negative performance patterns, excessive absenteeism, or tardiness.

Employees of LaneStaffing, who test positive or admit to substance abuse will be referred to local public agencies that provide rehabilitation and counseling services. The result of all drug testing will be confidential, and for no other purpose than for LaneStaffing, to make employment related decisions.

BACKGROUND INVESTIGATION CONSENT FORM

I, (applicant complete name), hereby authorize LaneStaffing, Inc. and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal, or police records, including those maintained by both public and private organizations and all public records 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 now, and if applicable LaneStaffing, Inc.

POLICIES AND PROCEDURES ACKNOWLEDGEMENT

I have a working telephone and reliable adequate transportation. I agree to accept assignments in greater Houston and that my rate of pay may vary by assignment. I understand that I am expected to complete any job assignment I accept. If you do not complete the assignment, then LaneStaffing can assume that I have voluntarily quit. I understand that I am an employee of LaneStaffing, and only LaneStaffing, or I can terminate my employment. When an assignment ends, I must contact LaneStaffing, immediately to inform them of my availability. I must contact LaneStaffing, no later than Friday of each week for my next assignment. Failure to do so or to accept my next job assignment will indicate that I have voluntarily quit or am no longer available for work and my unemployment benefits may be denied. If for some unexpected reason, such as emergency illness, I cannot make it to work or will be late by more than 15 minutes, I will contact LaneStaffing, as soon as possible so they can call the client and or find a replacement. LaneStaffing, has a 24 Hour, 7 Day a Week Voicemail System. If I sustain an injury on the job, I will inform the client and LaneStaffing, immediately. LaneStaffing will coordinate with the client and me the proper procedure for treatment and reporting the accident. I have read, fully understand and agree to abide by each of the policies, procedures and agreements detailed above. I acknowledge this by initialing the list below and with my signature:

DISCLAIMER AND SIGNATURE

We will not check your current employer as a reference unless you give us permission.

Notice: Title 15 of the U.S. code, Section 1681 requires that we advise you that a routine inquiry may be made regarding character and general reputation. Upon written request, additional information as to the nature of the report will be provided to your or your appointed representative.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I authorize my current and former employers to give any information regarding me or my employment to LaneStaffing representatives.

I authorize schools and other educational institutions which I may have attended to reveal my scholastic rating to LaneStaffing representatives.

I agree to undergo any medical evaluation or drug screenings and tests as may be required in accordance with applicable laws and regulations. Any offer of employment may be subject to revocation or my employment may be terminated on the basis of drug screening tests.

If employed, I agree to comply with all safety rules and to wear or use protective clothing or equipment as required.

I agree that, if employed, I will not divulge any information confidential to LaneStaffing or any of its affiliates or clients while employed or at any time thereafter.

I agree to call in to register as "available for work" upon completion of my assignment. Failure to do so will result in forfeiture of my rights to unemployment compensation.

I understand that any employment offered to me will not be for any definite period of time and is subject to termination with or without cause by either party at any time. I also understand that my employment is -at-Will, and Thal no statement have been made to the country and this policy cannot changed except in writing signed by an officer of LaneStaffing.


DRUG AND ALCOLHOL TESTING POLICY STATEMENT AND CONSENT FORM

LaneStaffing is committed to maintaining a safe, productive work environment at all facilities and work sites to which it assigns associates and to safeguarding all property connecting with such employment. Because the concerns for safety of ail LaneStaffing associates is paramount. The signing of the Drug and Alcohol Testing Consent Form constitutes agreement and cooperation with this policy is required of all persons as a condition of employment by LaneStaffing.

It is the policy of LaneStaffing not to assign or retain any individuals who test positive for any illegal drug in their system or use illegal drugs or a controlled drug, in any amount, regardless of frequency, without a medically acceptable prescription. Therefore, to rule out the presence of non-prescribed or prohibited dangerous controlled substances in the body, all LaneStaffing associates may, consistent with state law, be required to undergo a drug screening test for any or all of the following reasons:

  • Pre-employment (assignment) purposes
  • Continuation of employment (assignment)
  • Periodic, announced (routine) testing
  • Randomly to ensure consistently and continuance of policy
  • For cause do to reasonable suspicion by LaneStaffing or its clients
  • Post-accident (work-related injury)

In addition, LaneStaffing associates may be required to undergo alcohol screening, when there is suspicion of impairment or critical event (work-related injury, unusual behavior etc).

I understand that according to LaneStaffing policy. I may be required to submit a sample of my urine and/or other body fluids, tissue or filaments for chemical analysis. I understand that the analysis will be performed by qualified personnel.

I consent freely and voluntary to this request for a specimen or specimens of urine and/or other body fluids, tissue or filaments. I hereby and herewith release LaneStaffing, the medical provider obtaining the samples and the laboratory performing the analysis (including its employees, agents, and contractors) from any liability whatsoever arising from this request to furnish my urine and/or other body fluids, tissue or filaments the testing of the sample and decisions made concerning my employment based upon the results of the analysis.

I understand that any person refusing to take or failing to pass the drug screening test will not be qualified for employment or any assignments with LaneStaffing until a negative drug test result can be obtained on the LaneStaffing test. Initial testing and confirmation tests for positive results are at the expense of LaneStaffing. Re¬testing is at my expense, consistent with state law.

I have read the foregoing policy statement and consent form and understand and agree to submit to drug and alcohol testing as part of the terms and conditions of my employment with LaneStaffing.




APPLICANT,

PLEASE DETACH THIS DOCUMENT FROM THE PACKET AND TAKE WITH YOU.

CONSUMER NOTIFICATION

Please be advised LaneStaffing, Inc. and/or its clients may obtain an investigative consumer report (i.e. background check, credit check, etc. ("Report") from a consumer reporting agency pursuant to the Fair Credit Reporting Act as amended by the Consumer Reporting Reform Act of 1996. The Report is being obtained for the purpose of evaluating you for employment, promotion, reassignment or retention as an employee.

This report may contain information bearing on your credit worthiness, credit standing, credit capacity, character, criminal background, general reputation, personal characteristics, or mode of living from public record sources or through personal interviews with your neighbors, friends or employees. You may also have a right to request additional disclosures regarding the nature and scope of the investigation. This information may also be shared with Staffing Provider's clients in evaluating your eligibility for an assignment with such client.

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