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Grizzly Glass & Mirror, Inc

By Alfred Watson,2014-04-11 22:31
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Grizzly Glass & Mirror, Inc

Grizzly Glass & Mirror, Inc

Pay Schedule:

     Time starts on Monday morning and ends on Sunday evening.

     Time is held back one week.

     If you start on Monday, it will be two weeks before you get a paycheck.

    If you report directly to a jobsite, the foreman will record your time daily on the

    Foreman Timesheet. Initial this at the end of the week to show you are in

    agreement with the times submitted.

    If you report to the shop first, you must use a punch card be sure to include the

    job name that you are working on.

    It is your responsibility to turn in time. No time card, no paycheck.

    PERSONAL INFORMATION

    NAME:

    FIRST: _________________ MIDDLE: _____________ LAST: ________________

    MAILING ADDRESS:

    SOCIAL SECURITY #: _____ - ____ - _____

    BIRTHDATE: _____ / _____ / _______

    DRIVER’S LICENCE #: _______________

     TYPE: ________ EXP DATE: _____________

    TELEPHONE #: _____ - _____ - _______

    CELL PHONE #: _____ - _____ - _______

    SPOUSE’S NAME: ___________________________

    PERSON / PERSONS AUTHORIZED TO PICK UP PAYCHECK:

    NAME: _________________________ RELATION: ____________________

    NAME: _________________________ RELATION: ____________________

    EMERGENCY CONTACT NAME, PHONE # AND RELATION:

    NAME: _________________________ RELATION: ____________________

    PHONE: _________________________

    NAME: _________________________ RELATION: ____________________

    PHONE: _________________________

    EMPLOYMENT INFORMATION

    Applicant’s Name: ________________________________________________________

Present Address: ________________________________________________________

     ________________________________________________________

     Last Employer Name:

Phone #: Wage Amount:

Address:

    Position Held: From: To:

    Reason For Leaving:

    Second Last Employer:

    Phone #: Wage Amount:

    Address:

    Position Held: From: To:

    Reason For Leaving:

    Third Last Employer:

    Phone #: Wage Amount:

    Address:

    Position Held: From: To:

    Reason For Leaving:

    Signature: Date:

    MEDICAL QUESTIONNAIRE

    1. Are you currently taking regular medication to control epilepsy, seizures, fainting, etc. ?

    Yes: No:

    If yes, explain:

2. Are you currently taking any form of medication or tablets, capsules, etc., for

    losing weight ?

    Yes: No:

    If yes, explain:

    3. Have you ever had a head injury ?

    Yes: No:

    If yes, explain:

    4. Have you ever had a seizure, fit, convulsion or fainting ?

    Yes: No:

    If yes, explain:

    5. Have you ever had muscle spasms, muscle strain or injury to your back ?

    Yes: No:

    If yes, explain:

    6. Have you ever had back surgery ?

    Yes: No:

    If yes, explain:

    7: Have you ever had other surgery ?

    Yes: No:

    If yes, explain:

    Continued…………………….

MEDICAL QUESTIONNAIRE CONTINUED

8. Have you ever been confined to a hospital or mental institution for illness or

    injury?

    Yes: No:

    If yes, explain:

    9. Have you ever had or do you currently have:

     a. High Blood Pressure Yes: No:

     b. Heart Problems Yes: No:

     c. Low blood pressure Yes: No:

    If yes, explain:

    Signature: Date:

STATEMENT TO BE READ AND SIGNED:

    I understand that any false answer or statements or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

    This certifies that this application was completed by me, and that all entries on it, and

    information it, are true and complete to the best of my knowledge.

    I hereby give Grizzly Glass & Mirror, Inc. the right to make a thorough investigation on

    may past employment and activities and I release from all liability all persons,

    companies and corporations supplying such information.

    Signature: Date:

WAIVER OF CONFIDENTIALITY

    I understand the information in my worker’s compensation file(s) is confidential under Article 8307, 69a, Revised Civil Statutes of Texas. However, I do hereby waive any such right of confidentiality and both authorize and request that such information be made available to Grizzly Glass & Mirror, Inc. whose address is 630 Tower Dr. Kennedale, TX 76060, to whom I have made an application for employment.

    Applicant’s:

     Signature:

     Print Name:

     Social Security No:

     Print Street Address:

     Print City, State, Zip:

     Date of application for employment:

    STATE OF TEXAS

    COUNTY OF TARRANT

    SWORN AND SUBSCRIBED TO BEFORE ME THIS DAY OF

    Signature of Notary

    Printed Name of Notary

    My commission expires

    This information is requested in accordance with the provisions of Article 8307, 69a,

    Revised Civil Statutes of Texas, as amended.

    Name of Requestor:

Title of Requestor:

    COMPANY POLICY

ABSOLUTELY NO DRINKING ALCOHOLIC BEVERAGES OR POSSESSION

    OF ANY TYPE OF ILLEGAL SUBSTANCE IN COMPANY VEHICLES.

    Anyone caught drinking any alcoholic beverage or in possession of any illegal

    substance in any company vehicle, on company property or on any

    construction site will be dismissed without warning.

    In the State of Texas, insurance companies will not cover any damages or

    personal injuries caused by anyone that is driving with the possession of

    alcohol or drugs. Anyone involved in an accident under the influence of

    alcohol or drugs, no matter who is at fault, will not be covered by insurance.

    Grizzly Glass & Mirror, Inc. will not accept responsibility of any illegal action.

    Any person or persons involved in an accident while under the influence of

    alcohol or drugs are liable for any and all damages caused by such accident

    and agree to accept full responsibility for any law suits by any other party for

    property damages and all personal injuries and by Grizzly Glass & Mirror, Inc.

    for any and all damages.

Employee Signature Date

Grizzly Glass & Mirror, Inc. Representative Date

State of Texas

    County of Tarrant

     Notary Public Date

    Grizzly Glass & Mirror, Inc.

    630 Tower Dr. Kennedale, TX 76060 Off: 817 483 4747 Fax: 817 483 4750 E-mail: ggbearit@sbcglobal.net

    DRUG FREE WORKPLACE POLICY

    Recognizing that employees are the most important asset of any organization, and that the health and safety of every single employee is of utmost concern to Grizzly Glass & Mirror, Inc., this policy is being implemented for the purpose of eliminating drug use and its negative consequences in the workplace. Employees who abuse drugs are a danger to themselves, their co-workers, and the company.

    For purposes of this policy, “Company” is defined to be Grizzly Glass & Mirror, Inc.

    For purposes of this policy, “Drugs” is defined to be:

     a) Alcohol;

     b) Inhalants or illegal drugs, including narcotics, marijuana, cocaine, designer drugs such as

     ecstacy, hallucinogens, illegal inhalants, or any other drug not legally obtainable.

     c) Prescription drugs, except when taken as directed by the employee’s doctor (documentation

     may be required).

    For purposes of this policy, “Workplace” is defined as:

     a) Any Company premises;

     b) In any vehicle owned or leased by the Company;

     c) On any work site while representing the Company.

    All applicants for employment by the Company may be required to submit to a pre-employment drug

    screening prior to starting work as a new employee. A positive result on the drug test will result in the

    applicant being rejected.

    Any employee injured in a job-related accident will be required to submit to a drug test in conjunction

    with treatment for the injury. A refusal to take the test, or a positive test result, will be considered

    misconduct and grounds for immediate termination, and may result in a denial of benefits.

    Random testing may also be conducted.

    Reporting to work under the influence of drugs, consumption of drugs during work hours, and/or

    possession, sale or transfer of illegal drugs at the Workplace, will all be considered misconduct and

    grounds for immediate termination.

    While we do not sponsor, participate, or endorse any specific drug treatment or education programs.

    Such programs are available through public and private sources. Employees who abuse drugs are a

    danger to themselves, their co-workers, and the company facilities in our area. Affected employees are

    encouraged to seek assistance for themselves and their dependents.

    Applicant’s Signature Printed Name

    Date:

    DRUG ABUSE POLICY OF GRIZZLY GLASS & MIRROR

    Statement of Purpose and Scope

    Grizzly Glass & Mirror, Inc. recognizes that alcohol and drug abuse in the workplace has become a major concern. We believe that by reducing drug and alcohol abuse, we will improve the safety, health and productivity of employees. The object of our drug and alcohol abuse is to provide a safe and health workplace for all employees, prevent accidents and comply with Section 7:10 of the Texas Worker’s Compensation Act.

    The use, possession, sale, transfer, purchase or being under the influence of drugs by employees at any

    time on company premises or while on company business is prohibited. The illegal use of any drug is

    prohibited. Employees must not report for duty or be on company property while under the influence

    of, or have in their possession while on company property, any drug.

    Definition of Drug

    For the purpose of this policy, the term “Drug”, wherever it appears in this policy statement, includes

    alcoholic beverages as well as inhalants and illegal drugs.

    Conseguences of Violating the Drug Abuse Policy

    Violation of this drug abuse policy will result in one of the following forms of corrective action:

    Immediate discharge, suspension, probation, oral warning or written warning. In arriving at a decision

    for proper action, the seriousness of the infraction, the past record of the employee, and the

    circumstances surrounding the matter will be taken into consideration.

    Treatment Programs

    While we do not sponsor or endorse any specific drug treatment programs, such programs are

    available through public and private health care facilities in our area. Affected employees are

    encouraged to seek assistance for themselves and their dependents.

    Education and Training Programs

    We do not offer, nor require participation in, drug and alcohol abuse education and training programs.

    However, various public and private facilities in our area offer such programs and affected employees

    are encouraged to seek assistance.

    Drug Testing

    We do not require drug testing as a condition for employment. However, you may be subject to

    random drug testing.

    I have read and understand this drug abuse policy and agree to abide by its terms and conditions.

    Employee Signature: Date:

    Printed Name:

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