Application Form

Open Position: Inspector


PERSONAL DATA

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EMPLOYMENT HISTORY

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POSITION APPLIED FOR

Can you work

VOLUNTARY SELF-IDENTIFICATION

It is the policy of Target Engineering Group to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including, but not limited to, recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company-sponsored employee activities.

 

In an effort to comply with requirements regarding government record keeping, reporting, and other legal obligations that may apply, please complete this applicant data survey. Failure to provide the information will not subject you to any adverse personnel decision. Your cooperation is appreciated.

This survey is NOT a part of your official application for employment. It will not be used for interview purposes or in any hiring decision. The information will be filed separately from your application and will be used and kept confidential in accordance with applicable laws and regulations.

Vietnam-era Veteran

APPLICANT’S ACKNOWLDGEMENT

I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document may be cause for my dismissal at any time without prior notice. I consent to and authorize this Company to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give the Company (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing a good faith reference.

I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR MY EMPLOYER WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTES AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE EMPLOYER. I ALSO UNDERSTAND THAT THIS ASPECT OF MY EMPLOYMENT MAY NOT CHANGE ABSENT AN INDIVIDUAL WRITTEN AGREEMENT SIGNED BY BOTH ME AND THE PRESIDENT OF THE COMPANY.

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation; take a pre-employment drug test. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required tests. I authorize the release of any background check results of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document.

I acknowledge that this application will remain active for 30 days from this date. If I have not heard from the Company at the conclusion of this 30 day period, it is my responsibility to complete a new application if I still wish to be considered for employment.

CALIFORNIA APPLICANTS ONLY: I understand the Company may obtain, without using the services of a third party investigative consumer reporting agency, public records pertaining to my character, general reputation, personal characteristics or mode of living during its evaluation of my application for employment and, if employed, during my employment. By checking the following box, I waive my right to receive copies of public records obtained by the Company.

DRUG FREE WORKPLACE PROGRAM POLICY

Target Engineering Group
Drug Free Workplace Program Policy

60 DAY NOTICE TO APPLICANT AND EMPLOYEES OF DRUG FREE WORKPLACE PROGRAM

This company has an established Drug Free Workplace Program. Employees are prohibited from using illegal drugs (including the non-prescribed use of prescription medication) on or off the employer's premises. Employees are also prohibited from possessing or transporting alcohol or illegal drugs on the premises. Employees may only transport alcohol onto the employer's premises if it is part of the employee's job responsibilities. Possession of paraphernalia used in connection with the use of any drug is evidence of violation of this rule.

Drugs mean alcohol, including distilled spirits, wine, malt beverages and intoxicating liquors, amphetamines, cannabinoids, cocaine, phencyclidine (PCP), hallucinogens, methaqualone, opiates, barbiturates, benzodiazepines, synthetic narcotics, designer drugs or metabolite of any of these substances. Non-prescribed use of prescription medication is also prohibited.

This company will require all applicants for employment and all existing employees, under certain circumstances, to be tested for the presence of drugs or alcohol as part of this company's policy prohibiting drug or alcohol use. An employee violates the Drug Free Workplace Program by testing positive in a confirmed test for drugs. Refusal to cooperate in the drug testing procedure is an independent violation of this rule and accordingly, will be treated as a positive confirmed test for drugs. Upon conviction for violating any state or federal drug law, each employee of this company is required to notify his or her immediate supervisor of such conviction within five business days thereof. This "notification of drug conviction" requirement applies whether the conviction resulted from conduct performed while in the course and scope of employment or off duty. Employees are required to report any drug related criminal charge brought against them, whether the result of on-duty or off-duty conduct.

Any violation of this rule will result in discipline, up to and including discharge and possible forfeiture of workers' compensation medical and indemnity benefits.

This notice is given on APRIL 1st, 2014. Drug testing may begin 60 days after the date of this notice.

Signed By: RAMZI ASFOUR, P.E.

AN OPEN LETTER TO ALL EMPLOYEES

We have recognized that drug and alcohol abuse is an on-the-job problem as well as a social problem in Florida. We believe that abuse of alcohol, and the use of illegal drugs, endangers the health and safety of the abusers and of others around them.

Target Engineering Group, Inc. has committed to creating and maintaining a Drug Free Workplace without jeopardizing the job security of valued but troubled employees, provided they are prepared to help us help them.

Notice is posted in a conspicuous location identifying our company as a Drug Free Workplace. Copies of the Drug Free Workplace policy are available for inspection at the Human Resources office.

Our Drug Free Workplace Policy now formally states that substance abuse will not be tolerated ON or OFF the job for employees of our company. This prohibition includes the possession, use or sale of illegal drugs, the abuse of alcohol and abuse of prescribed drugs. Company sponsored activities or other social events that we attend during which alcoholic beverages are served are not considered alcohol abuse just because alcohol was served.

All Target Engineering Group, Inc. employees are expected to sign a statement of understanding and agreement with the company's Drug Free Workplace Policy.

To ensure that this company remains a Drug Free Workplace, a program of drug testing is in effect. Let it be clearly understood that it is a condition of employment for everyone that they avoid entirely the use, possession, sale or any association whatsoever with illegal drugs and/or the abuse of alcohol. Employees who are found on the job to be under the influence of illegal drugs or alcohol or who violate this policy in other ways will be terminated. It is important that all of us work together to deal with substance abuse to make our company a safer and more rewarding place to work.

Sincerely,

RAMZI ASFOUR, P.E.

DRUG FREE WORKPLACE PROGRAM

I. STATEMENT OF POLICY

In order to establish Target Engineering Group, Inc. as a Drug Free Workplace and thereby increase the safety and health of our employees and their families, this Policy requires that employees of our Company shall not use drugs illegally at any time, shall not use or be under the influence of alcohol while working and shall not use or be under the influence of medications, while working, that could affect their ability to work safely.

II. DEFINITIONS

AHCA

Agency for Health Care Administration, formerly HRS.

Alcohol

Liquids containing ETHYL ALCOHOL (ETHANOL).

Drugs

One or more of the following named substances: AMPHETAMINES, CANNABINOIDS (MARIJUANA), COCAINE, PHENCYCLIDINE (PCP), METHADONE, PROPOXYPHENE. OPIATES, METHAQUALONE, BARBITURATES, BENZODIAZEPINES,
See Section M for common brand Names.

Medications

Prescription and Non-prescription substances obtained and used legally to combat illness and injury or for other therapeutic reasons.

Work(ing)

Performing any activity under any conditions during any period of time that an employee is covered by the Employer's Workers' Compensation insurance (i.e. driving, on duty, on call or performing any tasks as a part of employment duties; lease and contract employees included).

Influence

To be physically, mentally or emotionally subject to the effects of any substance.

Company

Target Engineering Group, Inc.

Employer

Target Engineering Group, Inc.

Employee

Anyone employed by or contracted with the company who is covered by workers' compensation insurance obtained by the company.

Use(ing)

As pertains to drugs, alcohol and medications; to drink, smoke, apply topically, inject, possess, solicit, distribute, dispense, manufacture or transfer.
Exceptions to these rules regarding the definition of "use" will be allowed only with Management's written permission.

III. POLICY WORK RULES

A. DRUGS

Employees shall not use or be under the influence of drugs illegally at anytime, whether working or not working.

B. ALCOHOL

Employees shall not use or be under the influence of alcohol while working.

C. MEDICATIONS

Employees shall not use or be under the influence of medications while working if the medications have the potential to alter or to adversely affect their judgment, motor skills, to induce sleepiness or to otherwise detract from their safe job performance. Exceptions can, of course, be made in work areas and activities of decreased safety sensitivity where the potential for accident and injury is minimal and where the effect of the medication on the employee is judged to be no factor by medical authority. It must also be acceptable to management for the employee to continue work. Exceptions to this rule (Section C) will be made at least one level of supervision above the concerned employee's immediate supervisor. Employees will report their use of medications to their supervisor before beginning work; those sensitive to the disclosure of their use of certain medications may call or visit the company official (see name and telephone number in Section N) in charge of the Drug Free Workplace Program, in confidence to resolve their unique work situation.

D. DRUG FREE WORKPLACE PROGRAM MONITORING

To measure the success of, and to aid in enforcing, our Drug Free Workplace Program, the following types of drug screening tests will be administered to detect the presence of illegal drugs or alcohol.

  1. Job applicants, as a condition of obtaining employment
  2. Employees who are required to undergo FITNESS FOR DUTY MEDICAL EXAMINATIONS.
  3. Employees as a FOLLOW-UP to a return from rehabilitation program. These employees will be tested periodically.
  4. Employees who, by reliable evidence, or by their observed or reliably reported behavior, may be REASONABLY SUSPECTED of: (a) Using or being under the influence of drugs, alcohol or medications while working. (b) Tampering with a drug screen test. (c) Causing or contributing to an accident involving a reportable injury (i.e. an injury sufficient to require the attention of a medical professional), lost time and/or property damage sufficient to delay or halt work. The employees as soon as possible, but not later than 32 hours after the accident, must provide all specimens.
  5. UNDER A RANDOM TESTING SCHEDULE, at least TEN PERCENT OF THE WORKFORCE TO BE TESTED ANNUALLY WITH EMPLOYEES SELECTED QUARTERLY FOR RANDOM TESTING.

Notice of Drug Testing will be given on all vacancy announcements. In addition to the drugs named in Section D above, a test for the presence of alcohol may be administered as a result of the conditions stated in Section D.4. (a), (b) and (c) above.

A copy of documentation supporting a REASONABLE SUSPICION drug and alcohol test will be completed within seven (7) days after testing, will be provided to the employee upon request, and will be retained confidentially by the company for at least one (1) year.

Testing for the presence of drugs and alcohol will be performed by an AHCA approved laboratory after obtaining urine specimens for drug tests and blood samples for alcohol tests. All positive specimens from the initial screening are then tested a second time using a different technique and chemical principal from the initial test to insure reliability and accuracy. All test results are reported to the Medical Review Officer for verification prior to being transmitted to the employee and/or employer.

E. CONSEQUENCES TO EMPLOYEES OF:

(1) POSITIVE CONFIRMED DRUG OR ALCOHOL TESTS

(2) REFUSAL TO BE TESTED FOR DRUGS OR ALCOHOL

(3) ANY PLEA OF GUILTY OR NOLO CONTENDERE TO ANY VIOLATION OF CHAPTER 893 OR OF ANY CONTROLLED SUBSTANCE LAW OF THE UNITED STATES OR ANY STATE, FOR A VIOLATION OCCURRING IN THE WORKPLACE.

(4) CONSUMPTION OF ALCOHOL OR INTOXICATION ON COMPANY TIME.

(5) ADULTERATED OR SUBSTITUTED SPECIMEN SUBMITTED FOR TESTING

1. Job Applicants will not be hired.

2. Employees being tested in conjunction with a physical examination, as a follow-up to rehabilitation, as a result of reasonable suspicion behavior, a random test or because of contributing to or causing an accident (no injury involved) will FACE DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT.

Injured employees, in addition to above disciplinary action, may also forfeit eligibility for workers' compensation medical payments and indemnity payments.

3. Employees arrested, indicted or convicted of violating controlled substance laws will notify the employer within five (5) days of the event and if this substance abuse policy was also violated, will be disciplined up to and including termination, depending on the circumstances.

4. In the event under this policy an employee is required to seek a treatment plan, it will be at employee’s expense. The employee must provide documentation of that treatment program, and be required to be drug and/or alcohol tested unannounced (at employee's expense) EVERY SIX MONTHS FOR TWO YEARS. A positive confirmed test during or after treatment will result in termination of employment.

F. CHALLENGES TO CONFIRMED POSITIVE TEST RESULTS

A job applicant or employee will receive written notification of positive confirmed test results from the company within five (5) working days of the company's receipt of a report of a positive confirmed test result from the Medical Review Officer. This notification will also state the consequences of the positive confirmed test result. A job applicant or employee who receives written notification of (1) a positive confirmed test result and (2) the consequences to the employee of that result will have the opportunity within five (5) working days to explain or contest the result. If the explanation or challenge of the positive test result is judged unsatisfactory by the company, the job applicant or employee will be provided with a written explanation as to why the explanation of the positive test result was unsatisfactory, along with a written report of the positive test results within fifteen (15) working days. If the test was for reasonable suspicion, the employee will receive in writing within seven (7) days after the test, if requested, a detail of the circumstances, which formed the basis of the determination that enough reasonable suspicion existed to warrant the testing.

During the 180-day period after written notification of a positive test result, the employee who provided the specimen should be permitted by the employer to have a portion of the specimen re-tested at the employee's expense. Such re-testing shall be done at another SAMHSA certified laboratory, as appropriate, chosen by the employee or job applicant. All such documentation will be kept confidential and retained by the company for at least one (1) year. Should the job applicant or employee then choose to further pursue the challenge it will then be the employee's responsibility to notify the laboratory to retain the sample until the case is settled.

G. CONFIDENTIALITY OF DRUG TESTING INFORMATION

All written reports and related information received by the company, laboratories, employee leasing programs, drug and alcohol rehabilitation programs and their agents will be held in strictest confidence and will not be disclosed except in accordance with Florida Statutes or otherwise legally disclosed. Release of such information under any other circumstance shall be solely pursuant to a written consent form signed voluntarily by the person tested. Information on drug test results shall not be released or used in any criminal proceeding against the employee or job applicant.

Agents of our company and the laboratory conducting a drug test will, however, have access to drug test information when consulting with legal counsel in connection with actions brought against them when the information is relevant to its defense in a civil or administrative matter.

H. CONFIDENTIAL REPORTING OF MEDICATION USE

The company knows that eventually most people need to take medications to combat various illnesses. Employees must realize, however, that many medications will alter or affect a drug test. An employee could possibly test positive for a drug when taking medications prescribed by a doctor or bought over the counter at a pharmacy. Medications known to alter or affect a drug test are listed in Section M. The name of the testing laboratory is listed in Section N. Employees who want more technical information about medications may consult the testing laboratory. To avoid the potential problems created by a false test result, the company has implemented procedures to enable employees to confidentially report the use of medications. You may report the use of medications on the back of your copy of the chain of custody form after your specimen is collected and discuss only with the MRO.

I. EMPLOYEE ASSISTANCE PROGRAM

Our company maintains an Employee Assistance Program (EAP) that consists of referring employees and their families who suffer from alcohol or drug use problems to local drug and alcohol rehabilitation centers. The telephone directory yellow pages, under “Drug Abuse and Addiction - Information and Treatment”, list the names and locations of treatment centers. Also, the United Way, listed in the telephone directory white pages, offers many confidential services at no charge. Any costs of outside services are, however, the employee's responsibility.

Any employee who has not previously tested positive for drug or alcohol use and has not yet entered a drug and/or alcohol abuse rehabilitation program, may seek assistance for drug and alcohol problems before they lead to disciplinary actions.

No employee will be discharged, disciplined or discriminated against solely upon the employee's voluntarily seeking treatment for a drug/alcohol related problem if the employee has not previously tested positive for drug use, entered an employee assistance program for drug related problems, or entered an alcohol and drug rehabilitation program.

If an employee wishes to pursue help through the EAP, please contact the person listed in Section N for appropriate referral. In addition, Section O lists national hotline numbers for drug and alcohol problems.

J. AUTHORITY TO ESTABLISH A DRUG FREE WORKPLACE PROGRAM

The company's Drug Free Workplace Program has been established in accordance with U.S. Federal and State laws regulations and guidelines.

K. FEDERAL AND STATE LAWS AND REGULATIONS

Nothing in this statement of policy shall be presumed to override, amend or change any requirements of State and/or Federal law. In the event any of the provisions of this policy conflict with applicable laws and regulations, such laws and regulations will be deemed to control.

L. AMENDMENT AND SEVERABILITY

The employer may amend this policy in any and all respects at any time. If any provision of this policy or the application thereof to any party or circumstance is held invalid or unenforceable, the remainder of the terms of this policy and the application of any invalid or unenforceable provisions to other parties or circumstances, will not be affected thereby, and to this end the provisions of this policy are severable.

M. SUBSTANCES WHICH COULD ALTER OR AFFECT THE OUTCOME OF A DRUG TEST (BRAND NAMES AND COMMON NAMES)

  • AMPHETAMINES: Abetrol, Biphetamine, Desoxyn, Dexedrine, Didrex
  • CANNABINOIDS: Marinol (Dronabinol, THC), Marijuana, Hash Pot
  • COCAINE: Cocaine HCI topical solution (Roxanne), Crack, Coke
  • PHENCYCLIDINE: Not legal by prescription; PCP, Angel Dust
  • OPIATES: Paregoric, Parepectolin, Donnagel PG, Morphine, Tylenol with Codeine, Empirin with Codeine, APAP with Codeine, Aspirin with codeine, Robitussin AC, Guiatuss AC, Novahistine DH, Novahistine Expectorant, Dilaudid (Hydromorphone), M-S Contin and Roxanol (morphine sulfate), Percodan, Vicodin, Opium, Heroin
  • METHAQUALONE: Not legal by prescription
  • BARBITURATES: Phenobarbital, Tuinal, Amytal, Nembutal, Seconal, Lotusate, Fiorinal, Firoicet, Esgic, Butisol Mebaral, Butabarbital, Butabital
  • METHADONE: Dolphine, Methadose
  • BENZODIAZEPINES: Ativan, Azene, Clonopin, Dalmane, Diazepam, Librium, Xanax, Serax, Tranxene, Valium, Verstran, Halcion, Paxipam, Restoril, and Centrax
  • PROPOXYPHENE: Darvocet, Darvon N, Dolene, Etc.
  • ALCOHOL: Liquid medications containing ethyl alcohol (ethanol). Please read the label for alcohol content. As an example, Vick's Nyquil is 25% (50 proof) ethyl alcohol; Comtrex is 20% (40 proof); Contac Severe Cold Formula Night Strength is 25% (50 proof) and Listerine is 26.9% (54 proof); Booze, Drink

N. DRUG FREE WORKPLACE POLICY - INFORMATION AND REVISION SHEET

THIS INFORMATION AND/OR REVISION NUMBER (original) March 2014

Company Drug Free Workplace Program Administrator: Adela Hamann

COMPANY LOCATION:

Target Engineering Group
359 Alcazar Ave.
Coral Gables, Florida 33134
305-446-2323

Your Drug Testing Laboratory is:

Pembrooke Occupational Health Inc.
2307 N. Parham Road
Richmond, VA 23229
804-346-1010

Your Collection Site is:

Several locations depending on worksite

Your MRO is:

Pembrooke Occupational Health
Dr. Stephen Kracht, MEDICAL REVIEW OFFICER
Medical Review Office
7500 W 110th ST., SUITE 400A
OVERLAND PARK, KS 66225
Phone: (888) 382-2281 Fax: (804) 346-5050

For EAP (Employee Assistance) Referral: Section O lists national hotline numbers for drug and alcohol problems. Florida Drug Screening, Inc. at 321 728 2941 can provide a list of treatment programs in your area. In addition, under contract with Florida Drug Screening, Inc – EAP provider - Employee & Family Assistance Consultants (321 723 8823) is available for (EAP) initial assessment and treatment referral

Employees being tested because of causing or contributing to an accident will ensure that testing is performed for both drugs and alcohol.

O. NATIONAL HOTLINE NUMBERS

Alcohol and Drug Referral Hot Line

1-800-252-6465

Child Help’s – National Child Abuse Hot Line

1-800-422-4453

National A.I.D.S. Hot Line

1-800-342-2437

National Cocaine Hot Line

1-800-262-2463

National Hepatitis Hot Line

1-800-223-0179

National Runaway Switchboard and Suicide Hot Line

1-800-621-4000

National Sexually Transmitted Disease Hot Line

1-800-227-8922

NATIONAL ASSISTANCE GROUPS

Alcoholics Anonymous

1-800-344-2666

Food and Drug Administration

1-301-443-1240

M.A.D.D.

1-800-438-6233

Narcotics Anonymous

1-818-780-3951

AL-ANON Family Group Headquarters

1-800-356-9996

National Institute of Drug Abuse, Drug Info., Treatment

1-800-662-4357

Families Anonymous

1-800-736-9805

S.A.D.D.

1-508-481-3568

Tough Love

1-800-333-1069

American Cancer Society

1-800-227-2345

Council of Compulsive Gambling

1-800-426-7711

PRE-EMPLOYMENT DRUG TESTING POLICY

All job applicants at this company will undergo screening for the presence of illegal drugs as a condition for employment.

Applicants will be required to voluntarily submit to a urinalysis test at a laboratory chosen by the company, and by signing a consent agreement, will release the company from liability.
(Any applicant with positive test results will be denied employment at that time.)

The company will not discriminate against applicants for employment because of past abuse of drugs or alcohol. It is the current abuse of drugs or alcohol, which prevents employees from properly performing their jobs that the company will not tolerate.

This policy statement is to be given out with all job applications.

PRE-EMPLOYMENT AGREEMENT

PLEASE READ CAREFULLY

I freely and voluntarily agree to submit to a urinalysis (drug screen) as part of my application for employment. I understand that either refusal to submit to the urinalysis screen or failure to qualify according to the minimum standards established by the company for this screen might disqualify me from further consideration for employment.

I further understand that upon commencement of employment with the company, I may again be required to submit to a urinalysis screen. I understand that refusal to take a requested urinalysis screen or failure to meet the minimum standards set for the screen may result in immediate suspension or discharge.

In the event that employment commences prior to the employer receiving the drug test results, I understand that I will be immediately discharged if the result comes back positive.

I have read in full and understand the above statements and conditions of employment.

Driver License Information: