Employee Acknowledgement Form
I acknowledge and understand that I am an employee of Integrity HR Management, LLC (IHRM) assigned to perform my job duties for my worksite employer (Client). As an assigned employee, I understand that IHRM maintains a co-employer relationship with the Client. The Client continues to assume the role of supervising, managing and controlling the assigned employees. The company of IHRM is responsible for administrative duties including, but not limited to, payroll, benefits, unemployment claims, and worker's compensation. I also understand that termination of the agreement between IHRM and Client may result in the dismissal of the employees from IHRM. I understand that IHRM, the Client, or I can terminate the employment relationship at any time, as I am an at-will employee. I acknowledge that there is no contract between myself and IHRM.
I also agree that if any time during my employment, I am subject to any type of discrimination or harassment, I will contact IHRM at 830-331-1300.
In the event my services are no longer required or needed at my work assignment, or if I am temporarily laid off, I will contact IHRM by the next business day for possible reassignment. Failure to contact IHRM may affect my eligibility for unemployment benefits. In the event that I am involuntarily terminated due to misconduct or other actions as stated in the handbook, then a complete separation of employment from IHRM will occur; and I will not be eligible for further assignment with IHRM.
If I am injured on the job, I must contact my immediate supervisor or a member of management with 24 hours of the injury. If the injury occurs on the weekend, I must report the injury immediately at 830-331-1300. Failure to repo1t any injury may result in loss of benefits. I understand that the injury is covered by the Texas Workers' Compensation Act, even if I am working out of the State of Texas.
I also understand that I am consenting to undergo drug and alcohol testing should I be injured. I hereby consent to the release to IHRM the results of such testing or any other medical records pertaining to an injury I may suffer as a result of my employment with IHRM. I understand that it is necessary for me to release such information to IHRM so that they may properly administer my workers' compensation benefits. I understand that testing positive will affect my employment and may result in a possible denial of workers' compensation benefits. I understand that the refusal to submit to testing will be considered a positive test and may also be considered cause for discharge.
If I am requested to submit to drug or alcohol testing for reasonable suspicion or random drug testing at any time, I will furnish a sample for analysis. I understand and agree that if, at any time, I refuse to submit to a drug or alcohol test or if I otherwise fail to cooperate with testing procedures, I will be subject to termination. I understand that only authorized officers ofIHRM and the Client will have access to information obtained in connection with this testing. All information will be kept confidential to the greatest extent possible.
INTEGRITY HR MANAGEMENT, LLC IS A LICENSED PROFESSIONAL EMPLOYER ORGANIZATION. UNRESOLVED COMPLAINTS REGARDING A LICENSEE OR QUESTIONS OR COMMENTS CONCERNING THE REGULATION OF STAFF LEASING SERVICES MAY BE ADDRESSED TO THE DEPARTMENT OF LICENSING AND REGULATOIN, P.O. BOX 12157, AUSTIN, TX 78711.
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Document Name: Employee Acknowledgement Form
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