Employee Operator Form

EMPLOYEE OPERATOR FORM

Personal Information

Phone:     Email:

Date of Birth:     Emergency Contact Name:     Emergency Contact Phone:

Position Information

Reporting Manager:     Anticipated Start Date:

Operator Qualifications & Licenses

Do you hold a valid driver's license? Yes    No

License Type:    License Number:    Issuing State:

Expiration Date:     Endorsements / Restrictions:

Medical & Physical Information

Are there any physical limitations, restrictions, or required accommodations that may affect your ability to safely operate equipment? Yes    No

Are you willing to submit to pre-employment and/or random drug and alcohol testing where permitted by law? Yes    No

Employment History (Most Recent First)

Position / Title:     From:     To:

Position / Title:     From:     To:

Education

Graduation / Completion Date:

References

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Legal Disclosures & Authorizations

At-Will Employment: I understand that if I am employed, the employment relationship is at-will and may be terminated by me or the Company at any time, with or without cause or notice, unless a written agreement signed by an authorized representative of the Company provides otherwise.

Equal Opportunity: The Company is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Authorization to Obtain Records: I authorize the Company, its agents and designated representatives to obtain my employment history, motor vehicle records, criminal history, drug and alcohol testing results, medical records pertinent to fitness for duty, and other records necessary to determine my qualifications to perform operator duties. I authorize all former employers, licensing agencies and other persons to release such information to the Company.

Background Checks and Testing: I consent to pre-employment, post-accident, random, reasonable suspicion, and return-to-duty drug and alcohol testing consistent with applicable law and Company policy. I understand that certain operator positions may require periodic medical examinations and that continued employment may be contingent on successful completion of such examinations.

Safety Acknowledgment

I acknowledge that safe operation of equipment is a condition of employment. I agree to comply with all safety rules, attend required training, use personal protective equipment as directed, and immediately report safety incidents, hazards, or medical conditions that could affect my ability to operate equipment safely.

Safety Training Completed (if any):

Applicant Certification

I certify that all information provided in this Employee Operator Form and any attachments is true, complete and accurate to the best of my knowledge. I understand that any misrepresentation, falsification, or omission of material fact may result in rejection of my application or termination of employment if discovered at a later date.

Acknowledgment: I acknowledge receipt of the foregoing statements and authorize the Company to verify information provided. I understand that my signature below constitutes my consent to the authorizations contained in this form.

I have read and understand the statements above and I certify under penalty of perjury that the information I have provided is true and correct.

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