Complete the following section in detail, most recent employer or current employer first (include service in the Armed Forces of the United States, part time, summer employment, self employment, volunteer or temporary employment if applicable). It is not necessary to go back beyond 10 years.
Please provide the names and business telephone numbers of people who are familiar with your work experience and technical competence in the field for which you are applying. We prefer professional/technical associates and/or past supervisors with
whom you have worked By providing reference information, you are giving Central Plains Industries, LLC, LLC permission to contact these people.
SOUTH DAKOTA CONSENT TO UNDERGO DRUG
TESTING AND PRE-EMPLOYMENT PHYSICAL
(Conditional Offer of Employment)
I hereby agree, upon a request made under the Drug and Alcohol-free Workplace Program and the Safety Program of Central Plains Industries, LLC, LLC ("CENTRAL PLAINS INDUSTRIES, LLC"), and in response to a conditional offer of employment, to submit to a drug test and to furnish a sample of my urine and/or blood for analysis and to undergo pre-employment physical prescribed by the Company. I understand and agree that if I at any time refuse to submit to a drug and/or alcohol test and to undergo a pre-employment physical or if I otherwise fail to cooperate with the testing procedures, my conditional offer of employment will be rescinded and I will not be employed.
I further authorize and give full permission to have CENTRAL PLAINS INDUSTRIES, LLC, and/or CENTRAL PLAINS INDUSTRIES, LLC's nurse or physician, send the specimen or specimens collected to a laboratory for a screening test for the presence of drugs, and for the laboratory or other testing facility to release any and all documentation relating to such test to CENTRAL PLAINS INDUSTRIES, LLC and/or any governmental entity involved in any legal proceeding or investigation
that may arise in connection with the test.
I will hold harmless CENTRAL PLAINS INDUSTRIES, LLC, its nurse or physician, and any testing laboratory and hospital/clinic that CENTRAL PLAINS INDUSTRIES, LLC might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including the rescission of my conditional offer of employment, or any other kind of adverse employment action that might arise as a result of a positive test or my inability to pass the preemployment physical. I will further hold harmless CENTRAL PLAINS INDUSTRIES, LLC, its nurse or physician, and any testing laboratory CENTRAL PLAINS INDUSTRIES, LLC might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug test or pre-employment physical.
I understand that a positive test or my inability to pass the pre-employment physical may result in the immediate rescission of my conditional offer of employment and that I may, at the discretion of CENTRAL PLAINS INDUSTRIES, LLC, be allowed to retake the drug test prior to the withdrawal of my offer of employment. I agree that I will pay all costs and/or expenses incurred by CENTRAL PLAINS INDUSTRIES, LLC if a second drug test or pre-employment physical is administered