I certify by my signature below that I have provided full and complete information on my employment application to Marquette Transportation, LLC, regarding my previous and prospective employers. I understand and agree that if I have neglected to provide
this information completely and accurately, Marquette Transportation, LLC has complete discretion to terminate my employment.
I hereby state that I received and understand the contents of the Marquette Transportation Company, LLC ("Marquette Transportation") safety rules as pertains to the employment position for which I have applied or been offered. If I am put to work by Marquette
Transportation, I agree to read, understand, and abide by the rules and policies outlined in the Marquette Transportation Responsible Carrier Program as pertains to my employment, and I agree to complete the applicable orientation
and training requirements set forth in that Program.
In consideration of my application, I do hereby agree and consent to the following:
- I hereby authorize any present or former employers, Department of Motor Vehicles, public agencies, educational institutes, criminal justice agencies, financial institutions, or any other person or agency having knowledge of
me to submit information or opinions about myself, including data received from other sources, to Marquette Transportation for employment related purposes. I hold said persons and/or organizations blameless and without liability
for statements or opinions made regarding my character, experience or qualifications.
- I agree and consent that Marquette Transportation has my permission to obtain medical records relating in any way to any treatment that I have or may receive from any hospital, clinic, nurses, physicians, or other health care
providers of any kind as a result of any health insurance claims that I may submit arising from accident or illness that occurs during the course of my employment with Marquette Transportation. This authorization also specifically
gives my permission to Marquette Transportation to have oral communications when otherwise permitted by law with any such health care providers, hospitals, clinics, physicians and/or nurses regarding such treatments.
- I understand that as a condition of my employment, Marquette Transportation may require that I obtain an independent medical examination upon my reporting any accident, injury or illness and may require additional independent
medical examinations should I file suit against my employer, or begin treatment with any specific medical specialist.
- I agree to have a functional capacity physical examination and other medical examinations as requested by Marquette Transportation. I agree to discuss the requirements of the physical examination with the testing facility before
the testing begins, and to advise the facility of any limitations I may have in performing any particular test. I release and hold Marquette Transportation harmless from any claim I may have arising from injury that occurs
as a result of any examination, whether caused in whole or in part by negligence of Marquette Transportation.
- I further understand that it is my obligation to report to my employer immediately any claims of accident, injury, or illness; to return promptly phone calls from my employer; to provide promptly any medical bills, pharmaceutical
bills or request for further treatment; and to keep my employer fully informed of my medical condition, prognosis, and anticipated return to work date, as a condition of further employment, and for receiving approval of submitted
charged and expenses which may be related to any treatment.
- I understand that I must, as a condition for my continued employment and receipt of benefits, fully and promptly cooperate with my employer with regard to any request for information or assistance, including but not limited
to executing any release of medical or other records relating to an accident, illness, injury or any employment related matter or investigation.
- As an express condition of employment with Marquette Transportation, I agree to comply with and consent to the terms and conditions of the Marquette Transportation Drug and Alcohol Policy as stated in the Company Responsible
Carrier Program, Section 1, Part 1.3. I understand I will be drug tested prior to being put to work. I further understand that Marquette Transportation enforces a zero tolerance drug and alcohol policy.
I have read and agree to the Applicant, New Hire and Rehire Acknowledgements and Agreements.