I hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will bathe basis for termination. I hereby authorize Special Response Corporation to investigate my background inclusive of criminal records and verify this information. I understand that if employed, my employment will not before any fixed period of time and may biter minted by the company at any time. I also authorize Special Response Corporation to release the information contained herein and its findings and work history of my employment to other firms or persons upon request. I also understand and agree that I may be expected to work on a wide variety of job assignments in the Greater Metropolitan Area and agree to accept assignments for which I am qualified as they become available. I also understand my failure to report to Special Response Corporation, location/address for work will indicate I have quit. I also agree to submit to a drug screen upon request oars specified in the Special Response Corporation substance abuse policy.

Itis the purpose ofSpecial Response Corporation to help provide a drug free environment for our clients and employees.Withthisgoalandbecauseoftheseriousdrugabuseproblemintoday’sworkplace,weare establishingthefollowingpolicyforexistingandfutureemployeesofSpecialResponseCorporation: Special Response Corporation explicitly prohibits:
The use, possession, solicitation for, or sale of narcotics or other illegal drugs, alcohol, or prescription medication without a prescription on company or customer premises or while performing an assignment.
Being impaired or underthe influence of legal orillegal drugs or alcohol off the company or customer premises that adversely affects the employee’s work performance, his or her own or other’s safety at the workplace, or the employer’s reputation.
Special Response Corporation may drug test using S.A.M.H.S.A. standards by three methods:
Pre-Employment: As may be required by client
Randomly: A random selectionof some employees fortesting willbedone unannounced
For Cause: Whenitisthecompany’sbeliefthat a drugproblem exists, for-cause testing will be
utilized (such as evidence of drugs, accidents, injuries in the workplace, fights or other behavioral symptoms of drug abuse, negative performance patterns, excessive absenteeism or tardiness.)
Employees of Special Response Corporation who refuse to submit to drug testing, test positive, or admit to substance abuse will be subject to immediate termination
.Also, employees of Special Response Corporation who test positive or admit to substance abuse will be referred to local public agencies that provide rehabilitation and counseling services.
The results of all drug testing will be treated confidentially, and used for no purpose other than for Special Response Corporation to make employment-relateddecisions.

I hereby authorize and give full permission to have Special Response Corporation and/or their medical company physician send a specimen of my urine and/or blood to a laboratory for a screening test using S.A.M.H.S.A. standards for the presence of illegal drugs, alcohol, or prescription medication is taken without prescription.
I will hold all parties concerned harmless, meaning I will not sue nor hold responsible for any alleged harm to me orinterfering with my obtaining a job or continuing employment due to not submitting to the tests or as a result to the report of the tests. This includes but is not limited to, possible clerical or laboratory error
This policy and authorization has been explained to me in language I understand. I have been told that if I have any questions they will be answered about the test, they will be answered. I understand this is a legal and binding document, because special Response Corporation is paying for the examinations.
I understand Special Response Corporation will require a drug screen test whenever an on the job accident or injury is reported in accordance with Special Response Corporation policy. This form serves as my authorization and consent. My refusal to submit to drug testing will begroundsfor termination.

I, the undersigned, do hereby authorize Special Response Corporation to examine all criminal recordsand arrestsonfilewithinanyorallthe counties intheStateof Maryland oranyother state. Indoingso,I understand that I am waiving my right to confidentiality concerning my criminal history.

Special Response Corporation has developed these safety rules patterned afterthe Federal OSHA requirements. Read and become familiar with these rules, and other safety rules that apply to yourjob
1. Report an injury to your employer/supervisor immediately. 2. Report any observed unsafe condition to your employer/supervisor.
3. Horseplay is prohibited at all times
4. Thedrinking of alcoholicbeverages isnot permittedon thejob. Any employee discovered underthe influence of alcohol or drugs will not be permitted to work.
5. If you do not have current first aid training, do not move ortreat an injured person unless there is immediate peril, such as profuse bleeding or stoppage of breathing.
6. Appropriate clothing and footwear must be worn on the job at all times.
7. Where there exists the hazard of falling objects, and approved hard hat must be worn.
8. You should not perform any task unless you are trained to do so and are aware of the hazards associated with that task.
9.Youmaybeassignedcertainpersonalprotectivesafetyequipment. Thisequipmentshouldbeavailable for use on the job, be maintained in good condition, and worn when required.
10. Learn safe work practices. When in doubt about performing a task safely, contact your supervisorfor instruction and training.
11. The riding of a hoist hook, or on other equipment not designed for such purposes, is prohibited at all times.
12. Never remove or bypass safety devices.
13. Do not approach operating machinery from the blind side; let the operator see you.
14. Learn where fire extinguishers and first aid kits are located
15. Maintain a general condition of good housekeeping in your work area at all times.
16. Obey all traffic regulations when operating vehicles on public highways.
17. When operating or riding in company vehicles or using your personal vehicle for business purposes, the vehicle’s seat belt shall be worn.
18. Be alert to hazards that could affect you and your co-workers.
20. Always perform your assigned task in a safe and proper manner; do not take shortcuts. The taking of shortcuts and ignoring of established safety rules is a leading cause of employee injury.
19. Obey safety signs and tags.
20. Always perform your assigned task in a safe and proper manner; do not take shortcuts. The taking of shortcuts and ignoring I certify that I have read and understand and will abide by the above-listed safety rules. Failure to do so may be grounds for termination and may disqualify my insurance benefits. established safety rules is a leading cause of employee injury.
I certifythat I havereadandunderstandandwillabidebytheabovelistedsafetyrules. Failuretodo so may be grounds for termination and may disqualify my insurance benefits.

PLEASE RETURN THIS FORM SIGNED TO SPECIAL RESPONSE CORPORATION AFTER READING AND UNDERSTANDING THE RULES.
I have been instructed and understand the safety rules and regulation contained in the company’sGeneral Safety Rules. I acknowledge that I understand these rules and that I agree to follow them. When in doubt concerning safe job performance, I will speak to my immediate supervisor.
Also, I hereby acknowledge that I have received Hazard Communication Training as required by OSHA regulations. I acknowledge that I am aware of the various chemicals that I will be coming into contact with and the hazards these chemicals may pose. I acknowledge that I am familiar with Material Safety Data Sheets (MSDS) and where the MSDS Book can be found. I acknowledge that I may be required to use appropriate personal protection safety equipment when using certain chemicals. I further acknowledge that I will use personal protection safety equipment when required to do so

I haveinstructedtheaboveemployeeinthefundamental chemical hazardsasrequiredbyOSHA29 CFR1910.1200. I acknowledge thatthe employee hasbeen informed ofthe various chemicals thattheywill come intocontactwith. I alsoacknowledgethat I havereviewedthecontentsof a typicalMSDSwiththe employeeandinformedtheemployeewhere ourlocation’sMSDSbook canbefound. I furtheracknowledge that I have informed the employee of those chemicals they will come into contact with thatrequire the use of personalprotective safetyequipmentorthatthe employee knowswhereto obtainrequired personal protective equipment.

PLEASE RETURN THIS FORM SIGNED TO SPECIAL RESPONSE CORPORATION AFTER READING AND UNDERSTANDING THE RULES.