Application for Employment

Name

Address

Emergency Contact Information

Direct Deposit Agreement Form

Authorization Agreement

I hereby authorize SI CONTRACTING, INC. to initiate automatic deposits to my account at the financial institution named below. I also authorize SI CONTRACTING, INC. to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold SI CONTRACTING, INC. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until SI CONTRACTING, INC. receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.

Account Information

Signature

Self-Identification of Race/Ethnicity

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM

Anti-Discrimination Notice: It is an unlawful employment practice for an employer to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and conditions of employment, because of such individual’s race, color, religion, sex, or national origin.

This employer is subject to certain nondiscrimination and affirmative action recordkeeping and reporting requirements which require the employer to invite employees to voluntarily self-identify their race/ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal laws, executive orders, and regulations, including those which require the information to be summarized and reported to the Federal Government for civil rights enforcement purposes. If you choose to not self-identify your race/ethnicity at this time, the federal government requires this employer to determine this information by visual survey and/or other available information. For civil rights monitoring and enforcement purposes only all race/ethnicity information will be collected and reported in the seven categories identified below. The definitions for each category have been established by the federal government. If you choose to voluntarily self-identify you may mark only one of the boxes presented below.

INVITATION TO SELF-IDENTIFY

PLEASE ANSWER THE FOLLOWING QUESTION

Safety Statement

SI Contracting, Inc. is committed to employee safety and superior quality. It is SI Contracting, Inc.’s intention to provide and maintain a safe and healthy working environment for every employee while providing the highest level of quality and service available to our customers. SI Contracting, Inc. insists that every employee be educated and trained in safety and accident prevention, thus sharing in the responsibility of maintaining a hazard free work environment. SI Contracting, Inc.’s ultimate target is to achieve a zero accident and injury performance record while serving our customers with a speed and accuracy work ethic. This will be achieved through the continued promotion of safe, efficient, and productive work habits and by supporting this policy through on the job safety education and training. FALL PROTECTION POLICY 1. 2. 3. CHECK YOUR HARNESS FOR RIPS AND TEARS MAKE SURE DOUBLE LANYARD IS SECURE 100% TIE OFF 6FT AND ABOVE, POSITIONING HOOK DOES NOT COUNT

I have read and understood the company’s safety statement and agree to join in and share in the responsibility of on the job safety training.

Termination Policies

The following is a summary of SI Contracting, Inc.’s reasons for termination. This does not constitute or imply SI Contracting, Inc.’s termination policies are based wholly upon this document. This document is merely a partial list, for use by the new hire, to help understand some reasons for termination they may encounter. Reduction in force. Job completed. Rain-Flood-Snow (Weather). Labor dispute. Insubordination (Typically includes not eligible for rehire). Misconduct (Availability for rehire at superintendent’s discretion). Absenteeism (Availability for rehire at superintendent’s discretion). Under influence of intoxicants (Typically includes not eligible for rehire). Poor workmanship. Not qualified. Dissatisfied. Leaving town/state. Seeking other employment. Personal reasons. Sickness. Off job injury. Failure to report for work (No call/no show typically includes not eligible for rehire). Failure to report after: Bad weather/labor dispute/illness. Consistent early out (leaving early, after 3rd time typically includes not eligible for rehire) SI Contracting, Inc. does understand that special cases do exist and will review these on a case by case basis as they see fit.

By signing below I acknowledge that I have read and understand the termination reasons as set forth on this page. I understand that this is not a wholly inclusive list and there may be other reasons for my termination.

Employee Statement

I understand that SI Contracting, Inc. prohibits the use, possession, distribution, manufacture, dispensing, or other activities including illegal substances in the work place and that my employment is contingent upon being alcohol and drug free. If the results of my substance screen test prove positive for the presence of certain drugs, alcohol and/or any unreported prescription medications, I agree to pay for the cost of my drug/ alcohol screen test by having it withheld from my wages. I also agree that any tools checked out to myself during the course of my employment and NOT returned at the end of my employment with SI Contracting will be deducted from my last paycheck.

ALCOHOL/DRUG ABUSE POLICY

Medical Exam and Drug and Alcohol Testing Acknowledgement and Consent

SI Contracting, Inc. requires applicants who are being considered for employment to be medically and physically fit for the job(s) applied for. A urine test designed to detect the presence of drugs and alcohol in the body is given as part of employee screening. Any offer of employment is contingent upon the applicant passing the test. The testing is performed by an independent laboratory or a designated official selected by the company. The urine sample will be collected in private; you will be given an opportunity to report any medication you have taken in the two past weeks; positive results will be double tested; the laboratory will only disclose to the company your fitness for the job; and you will have an opportunity to challenge positive results. By signing below, you are acknowledging you understand and agree to the medical, physical, and testing requirements. You are also consenting to the test of a condition of initial or continued employment. SI Contracting, Inc. reserves the right to set testing time for applicants and/or employed personnel at its convenience.

CONSENT

I have carefully and thoroughly read the Alcohol/Drug Abuse Policy. I agree to follow that policy.

AUTHORIZATION/RELEASE FORM

Drug and/or Alcohol Screening

I understand that, as a condition of employment, I must voluntarily consent to and satisfactorily complete SI Contracting, Inc.’s job related medical inquiries, including a urine screening test, to determine the presence of certain drugs and/or alcohol. As a current employee of SI Contracting, Inc., I understand that the presence of one of more such drugs and/or alcohol will result in termination of my employment.

You have the right to refuse to take the test. Refusal is just cause for termination.

MEDICAL DECLARATION

ACCIDENT REPORTING POLICY

In the event an employee sustains a job related injury:

1. The employee must inform his or her immediate supervisor that he or she experienced an injury on the job. If the injury is not a life threatening injury, the employee will immediately cooperate with all investigations and complete all required paperwork at the time of the injury.
2. Initializing the “Have you been injured today” box on the daily sign-in sheet is required. If the “Have you been injured” box has not been initialed then the Company will not consider the injury as job related.
3. In all cases, an escort will assist the injured employee to the Company designated Medical Treatment Facility. Supervision may call the treatment facility and inform the treatment facility an injured employee is on their way. Under no circumstances is an employee to go to a medical facility on their own claiming they sustained a job related injury without first informing their immediate supervisor.
4. If an employee fails to follow the accident reporting policy, not only will the Company deny all such claims, the employee will be subject to disciplinary action up to and including termination.

By signing below, I acknowledge I have read the accident reporting policy, and I agree to follow the policy.

NO HARASSMENT POLICY

SI Contracting, Inc.’s Position on Harassment

SI Contracting, Inc. (“the Company”) is committed to maintaining a work environment that is free from discrimination where employees at all levels of the Company are able to devote their full attention and best efforts to the job. Harassment, either intentional or unintentional, has no place in the work environment. Accordingly, the Company does not authorize and will not tolerate any form or harassment of or by any employee (i.e., supervisory or non-supervisory) based on race, sex, religion, color, national origin, age, disability, or any other factor protected by law. The term “harassment” for all purposes includes, but is not limited to, offensive language, jokes, or other verbal, graphic or physical conduct relating to an employee’s race, sex, religion, color, national origin, age, disability, or other factor protected by law, which would make the reasonable person experiencing such harassment uncomfortable in the work environment or which could interfere with the person’s job performance.

Sexual Harassment

Sexual harassment includes: (a) physical assaults or physical conduct that is sexual in nature; (b) unwelcome sexual advances or comments or requests for sex or sexual activities linked to one’s employment or advancement, regardless of whether they are based on promises or threats; (c) sexual displays or publications such as calendars, cartoons or graffiti; (d) other verbal or physical conduct of a sexual nature that has the purpose or effect of interfering with an individual’s work performance, or creating an intimidating, hostile, or offensive work environment; or (e)retaliation for complaints of harassment. The Company regards all such pervasive conduct as creating a hostile and offensive work environment in violation of this policy, regardless of whether submission to such conduct is made either explicitly or implicitly a term or condition of employment. Examples of sexual harassment include sexual propositions, sexual innuendo, sexually suggestive comments, sexually-oriented “kidding,” “teasing,” or “practical jokes,” jokes about gender-specific traits, foul or obscene language or gestures, displays of foul or obscene printed or visual material, and physical contact, such as patting, pinching, or bushing against another’s body; or reading or otherwise publicizing in the work environment materials that are sexually suggestive or revealing.

Racial, Religious, or National Origin Harassment

Racial, religious, or national origin harassment deserves special mention as well and is expressly prohibited. Racial, religious, or national origin harassment includes any verbal, written, or physical act in which race, religion or national origin is used or implied in a manner that would make a reasonable employee uncomfortable in the work environment or that would interfere with the employee’s ability to perform the job. Examples of racial, religious, or national origin harassment include jokes that include reference to race, religion, or national origin; or use of language that is offensive due to a person’s race, religion, or national origin.

How to Report Instances of Harassment

The Company cannot resolve matters that are not brought to its attention. Any employee, regardless of position, who has a complaint of or who witnesses harassment at work by anyone, including supervisors, managers, employees or even non-employees, has a responsibility to immediately bring the matter to the Company’s attention by contacting the Company’s EEO Officer Don Dearden at (503) 839-5739.

How the Company Will Investigate Complaints

The Company will thoroughly and promptly investigate all claims of harassment. The Company will meet with the complaining employee to discuss the results of the investigation and, where appropriate, review the proposed resolution of the matter. If an investigation confirms that harassment has occurred, the Company will take corrective action, including such discipline, up to and including immediate termination of employment, as is appropriate. Claims of assault or the threat of assault, if proven, will result in dismissal. Complaints of harassment will be kept as confidential as possible. Information will be released only on a “need to know” basis and no employee will be subjected to retaliation by the Company because he or she has reported what he or she believes to be an incident of harassment.

EEO POLICY

As an Equal Opportunity Employer, it is our goal for this to be a pleasant working environment, free from discrimination, harassment, intimidation and coercion. As a federal contractor we are bound to live up to the provisions of the Civil Rights Acts of 1964, Executive Order 11246 and other laws and regulations relating to Equal Employment Opportunity and Affirmative Action. Any person who feels that he or she has experienced discrimination because of race, color, religion, sex, age, national origin, disability or veteran status should immediately contact the EEO Officer name below:

EEO OFFICER:

James Cohron

(503) 969-7665

OUR COMMITMENT TO AN EFFECTIVE NO HARASSMENT POLICY

Finally, if you feel that the Company has not met its obligations under the policy, you should contact the Company’s EEO Officer, Don Dearden, at (503) 839-5739. An effective No Harassment Policy depends on all of us, working together, to address this very important subject.

Employee Acknowledgement

I have read and understand the No Harassment Policies outlined above and I will abide by them as a condition of my employment with SI Contracting, Inc.

NEW HIRE HAND OUT

I have received, read, and understand the SI Contracting, Inc. New Hire Hand Out.