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I understand that submission to running an MVR (Motor Vehicle Report) is a condition of employment with R.W. Summers Railroad Contractor, Inc. I further understand that if I refuse consent for R.W. Sillv1MERS to obtain an MVR, that it couldmean refusal of employment and/or discharge may result.
In accordance with the FAIR CREDIT REPORTING ACT, R.W. SUMMERS RAILROAD CONTRACTOR INC. (hereinafter "Company") certifies that for each motor vehicle report it requests, the information contained therein shall be used solely for "employment purposes" as that tennis defined in the Fair Credit Reporting Act, 15 U.S.C. 1681-1681u, involving the driver and that it has a written authorization of thedriver on file. A motor vehicle report will be considered used for an "employment purpose" if it is used to evaluate a driver for the purpose of employment, promotion, reassignment, or retention as an employee.
By signing and dating this form, I consent to the Company obtaining an MVR report.
I hereby refuse to consent to the company obtaining all MVR report.
I understand that submission to testing for the presence of drugs and alcohol is a condition of employment with R. W. Summers Railroad Contractor, Inc. I further understand that (1) if I refuse to take the test(s), (2) if I refuse to authorize release of the test results to the Company, or (3) if the test results establish a violation of the Company's policies concerning drug and alcoholuse, disciplinary action up to and including discharge may result. In addition, I understand. that if I am injured during the course and scope of my job and have positive drug test result or refuse to be drug tested, I will forfeit my Workers' Compensation medical and indemnity benefits upon exhaustion of the procedures in Florida Statutes 440.102(5).
By placing my initials in the blanks below, and by signing and dating this form, I consent to take the test(s) and authorize release of any test results to the Company. I understand that I may be placed on suspension pending result of said test(s). I understand that should my test results beconfirmed positive, I will be subject to disciplinary action up to and including discharge for cause or in the case of a post-job offer pre-employment positive test result I will be denied employment and be required to pay the cost of the test.
By signing this form, I hereby release to the Company and the Medical Review Officer the results of the test(s) to which I have consented. I further authorize the Company to discuss the result with the Medical Review Officer, medical personnel/physician collecting the specimen, the testing facility, its directors, officers, agents, and employees responsible for administering the aforementioned test(s) of evaluating the result thereof. I understand that the test results can be used as a defense to any civil or administrative legal action to which I am a party. I understand that a positive drug test result may be raised by the Company as a defense to any claims for unemployment compensation benefits which I may have, and I further waiveany privilege I may have and agree that the results of any drug test may be used in evidence in any unemployment benefits claim proceedings.
I further release any testing facility and/or any physician who has tested me from any liabilityarising from the disclosure of any and all results, written reports, medical records, arid data concerning my test(s) to the designated Company officials.