Employee eRAILSAFE Forms

Employee eRAILSAFE Forms

Employee Name:   Employee ID:

Personal Information

Position Information

Employment Type: Full-time Part-time Contractor

Emergency Contact

Medical, Limitations & Safety Information

Do you have any medical conditions, physical limitations, or medications that may affect safe performance of duties? Yes No

I attest that I will notify the company promptly if my medical condition, medication, or physical capability changes in a way that may affect safe performance of my duties.

Training & Certifications

I have completed eRAILSAFE mandatory safety training: Yes No

Employment History (Most Recent First)

Employer 1

Employer 2

Education

Graduation Date:

Professional References

Reference 1

Reference 2

Reference 3

Legal Disclosures & Acknowledgments

At-Will Employment: I acknowledge that, unless an express written agreement provides otherwise, employment with the company is at-will and may be terminated by either party at any time, with or without cause and with or without notice.

I acknowledge and accept the At-Will employment statement.

Equal Opportunity: The company provides equal employment opportunity without regard to protected characteristics and makes employment decisions based on business needs, job requirements, and individual qualifications.

I acknowledge receipt of the Equal Opportunity statement.

Safety & Testing: The company requires compliance with safety rules and reserves the right to require drug and alcohol testing, fitness-for-duty evaluations, and medical examinations where permitted by applicable law and consistent with safety-sensitive duties.

I acknowledge I have read and will comply with the company safety policies and testing requirements.

Authorization to Contact & Background Checks

I authorize the company and its designated agents to contact current and former employers, educational institutions, licensing authorities, and references to verify information provided and to obtain any records or information relevant to my application and fitness for duty. I further authorize truthfully responding third parties to disclose such information to the company.

Background Checks and Screening: I consent to criminal background checks, motor vehicle record checks, drug and alcohol screening, and other pre-employment and ongoing checks as required for my position. I understand that a failure to consent may disqualify me from hire or continued assignment.

I authorize the company to obtain background checks and screening as described above and release all parties from liability for providing such information.

Applicant Certification & Release

I certify that all information provided in this form is true, correct and complete to the best of my knowledge. I understand that any misrepresentation or omission may result in withdrawal of an offer or termination of employment. I authorize investigation of all statements contained herein and release the company and persons providing information from liability for damages that may result from furnishing such information.

I understand and agree that this form does not constitute an employment contract and that any employment relationship is subject to the At-Will statement above unless otherwise expressly set forth in a signed written agreement.

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