Lone Star Employment Application Form

GENERAL SAFETY RULES

THE GENERAL SAFETY RULES ARE THE BASIC RULES THAT APPLY TO ALL Lone Star Resin Systems, Inc. EMPLOYEES WHILE ON THE JOB. IN ADDITION, THERE ARE NUMEROUS SAFETY RULES AND PROCEDURES THAT APPLY TO SPECIAL CONDITIONS. THESE WILL BE REVIEWED WITH THE EMPLOYEE ON A CASE BASIS WHEN APPLICABLE. ANY QUESTIONS REGARDING ANY SAFETY RULES WILL BE DIRECTED TOWARD COMPANY SUPERVISION.
1. APPROVED HARD HATS IN GOOD CONDITION SHALL BE STANDARD HEADGEAR ON ALL JOB SITES. METAL HATS WILL NOT BE PERMITTED.
1. SAFETY GLASSES WITH SIDE SHIELDS SHALL BE WORN ON ALL JOB SITES.
1. CHEMICAL GOGGLES SHALL BE WORN IN AREAS OF HIGH EYE HAZARDS OR REQUIRED BY DESIGNATED SIGNS.
1. EMPLOYEES SHALL CARRY APPROVED MOUTH BIT RESPIRATORS IN GOOD CONDITION WHERE APPLICABLE.
1. FACE SHIELDS & LONG SLEEVE SHIRTS TUCKED IN SHALL BE WORN WHEN GRINDING, CHIPPING, OR BREAKING INTO PIPELINES.
1. EMPLOYEES SHALL WEAR SHIRTS WITH SLEEVES, LONG TROUSERS OR OVERALLS ON THE JOB SITES.
1. WEARING CANVAS SHOES, SANDALS OR SNEAKERS IS NOT PERMITTED. SAFETY TOED FOOTWEAR REQUIRED.
1. WEARING JEWELRY ON THE JOB SITE IS NOT PERMITTED. ONLY WATCHES ARE ALLOWED.
1. SAFETY HARNESSES SHALL BE WORN AND SECURED FOR ELEVATED WORK WHERE NO PROTECTION IS AVAILABLE TO PREVENT THE WORKER FROM FALLING.
1. SMOKING IS PERMITTED IN DESIGNATED AREAS ONLY.
1. NO WORK SHALL BE PERFORMED IN THE PLANTS WITHOUT THE PROPER PERMIT.
1. EMPLOYEE SHALL KNOW ALL PLANT RULES AND ALARM SYSTEMS AT HIS JOB SITE.
1. EMPLOYEE SHALL UNDERSTAND AND OBEY LOCKOUT/TAGOUT RULES.
1. ALL UNSAFE WORKING CONDITIONS SHALL BE REPORTED TO THE FOREMAN IMMEDIATELY.
1. TOOLS SHALL BE USED ONLY FOR THE PURPOSE FOR WHICH THEY ARE DESIGNED.
1. DEFECTIVE TOOLS OR EQUIPMENT SHALL BE TAKEN OUT OF SERVICE IMMEDIATELY AND REPAIRED.
1. EMPLOYEE SHALL NOT OPERATE ANY EQUIPMENT OR VEHICLE UNLESS PROPERLY QUALIFIED.
1. ALL CLIMBING DEVICES SHALL BE CHECKED BEFORE USAGE. A STRAIGHT LADDER SHALL BE SECURED AT THE TOP. A SECOND EMPLOYEE SHALL SECURE THE LADDER AT THE BASE.
1. HORSEPLAY SHALL NOT BE TOLERATED.
1. DO NOT REPORT TO WORK WHILE UNDER THE INFLUENCE OF ALCOHOL OR ILLEGAL DRUGS. (SEE ALSO: DRUG, ALCOHOL, AND CONTRABAND INTERDICTION POLICY)
1. EMPLOYEE IS EXPECTED TO APPLY COMMON SENSE IN CARRYING OUT THE DUTIES OF HIS JOB.
1. SUPERVISION SHALL REPORT ALL INJURIES TO MANAGEMENT IMMEDIATELY.
1. ANY EMPLOYEE DEVELOPING A JOB RELATED INJURY OR ILLNESS DURING / AFTER WORK HOURS SHALL CONTACT THEIR SUPERVISOR OR A MEMBER OF MANAGEMENT IMMEDIATELY AND SEEK IMMEDIATE TREATMENT.
1. ALL EMPLOYEES ARE EXPECTED TO PARTICIPATE IN ALL SAFETY PROGRAMS AS DIRECTED BY THE COMPANY OR A CUSTOMER.
I UNDERSTAND THE GENERAL SAFETY RULES AND THAT WORKING SAFELY IS A CONDITION OF EMPLOYMENT AT Lone Star Resin Systems, Inc. (Type your name and the date below)
APPLICATION FOR EMPLOYMENT

Lone Star Resin Systems, Inc. IS AN INDUSTRIAL GENERAL CONTRACTOR ALL PROSPECTIVE EMPLOYEES SHALL REALIZE THAT EMPLOYMENT IS NOT FOR A DEFINITE PERIOD OF TIME AND MAY BE TERMINATED FOR ANY REASON.

PROVIDE THE INFORMATION REQUESTED. FAILURE TO DO SO SHALL RESULT IN DISQUALIFICATION OF YOUR APPLICATION.

A CANDIDATE FOR EMPLOYMENT WITH Lone Star Resin Systems, Inc. MUST SATISFY THE FOLLOWING – “PRE-EMPLOYMENT REQUIREMENTS”:
- COMPLETE THE APPLICATION
- COMPREHEND ENGLISH - COMPREHENSION OF ENGLISH IS A REQUIREMENT OF OUR CUSTOMERS IN ORDER TO UNDERSTAND THE IMPORTANCE OF “SAFETY IN THE WORKPLACE”. YOU MAY BE REQUIRED TO ANSWER VERBAL AND WRITTEN QUESTIONS TO DETERMINE YOUR COMPREHENSION.
- COMPLY WITH THE COMPANY DRUG/ ALCOHOL/ CONTRABAND INTERDICTION POLICY: THE COMPANY DRUG/ ALCOHOL/ CONTRABAND INTERDICTION POLICY WILL BE EXPLAINED TO YOU. YOU MUST READ AND SIGN A PRE-EMPLOYMENT DRUG SCREEN REQUIREMENT AND AN EMPLOYEE CONSENT FORM AGREEING TO COMPLY WITH THE SAID POLICY.
- COMPLETE THE NECESSARY SAFETY INDOCTRINATIONS:
CONTRACTOR SAFETY COUNCIL (GENERIC AND PLANT SPECIFIC)

TRI-CON (GENERAL, HAZ COM, LOCK-OUT / TAG-OUT, OTHER)
- COMPLETE OTHER QUESTIONNAIRES AND DOCUMENTS:
            W4                                                                               SAFETY HANDBOOK

            I9                                                                                 ORIENTATION VERIFICATION

            EMPLOYMENT REQUIREMENTS                                 CRAFT CERTIFICATION PROGRAM
- COMPLETE BACKGROUND SCREEN (IF APPLICABLE) APPROVED BY PLANT SECURITY
IF YOU QUIT WITHIN THE FIRST SIX WEEKS, ALL BACKGROUND, SAFETY TRAINING AND OTHER PRE-EMPLOYMENT CHARGES WILL BE DEDUCTED FROM YOUR LAST PAY CHECK.

I HAVE REVIEWED AND UNDERSTAND THE Lone Star Resin Systems, Inc. PRE-EMPLOYMENT REQUIREMENTS.
Signature and date
Name:*

First NameMiddle NameLast Name
Social Security Number:
TX DL or ID NUMBER:
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail Address:
Phone Number:*

Area CodePhone Number
Are you over 18 years of age?

YesNo
Do you have a legal right to work in the United States?

YesNo
What class is your driver's license?
HAVE YOU EVER BEEN ARRESTED (OTHER THAN A MINOR TRAFFIC VIOLATION)?

YesNo
If so, explain:
Educational Background:
High School

NameLocation
College

NameLocation
Trade School

NameLocation
Any other formal training that applies to the job you are applying for:
Personal References (not relatives or employers):
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Position or Positions Applying for:
What is your NCCER Status?

NoneAssessedCertifiedOther
Work History
Start Date

MonthDayYear
End Date

MonthDayYear
Business Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Job Title
Supervisor
Reason for Leaving
Pay Rate
Are you a previous employee?

YesNoOther
How did you hear about us?

NewspaperWebsiteOther
Do you have a TWIC card?

YesNoOther
DO YOU HAVE A SAFETY CARD FROM CONTRACTORS’ SAFETY COUNCIL OF BRAZOSPORT? (Answer each question below.)
Basic Plus or Ref.

YesNoOther
Dow Site

YesNoOther
Shintech Site

YesNoOther
I AM ELIGIBLE TO WORK IN DOW CHEMICAL (TEXAS DIVISION)

YesNoOther
I AM ELIGIBLE TO WORK IN SHINTECH INC. (FREEPORT SITE)

YesNoOther
In case of emergency please notify:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
I hereby authorize investigation of all facts contained in this application and agree to hold this Employer harmless. In addition, I authorize Lone Star Resin Systems, Inc. to investigate my past and present work, character, education, military and police records to ascertain any and all information which may be pertinent to my employment qualifications. I hereby acknowledge that falsification of said facts shall be cause for dismissal. I agree to release from liability or responsibility all persons and corporations supplying said information. In the event I am employed by Lone Star Resin Systems, Inc. I agree that my employment is not for a definite period and may be terminated at any time at the will of the company.
Applicant Signature
Date

MonthDayYear
Signature

Clear
Should be Empty: