Application For Employment
Position Applied for:
Karsten Interior Services, L.P. considers all applicants for employment without regard to race, color, religion, sex, national origin, age, disability, status as a Vietnam-era, or special disabled veteran in accordance with federal law. In addition, the Company complies with applicable state and local laws prohibiting discrimination in employment in every jurisdiction in which it maintains facilities.
Name: Social Security #:
Address: Apartment #:
City: State: Zip:
Phone #: Email: Referred By:
Date of Birth:
Are you over the age of 18? SelectYesNo
Do you have reliable transportation? SelectYesNo
Do you want to work SelectFull-timePart-time if part-time, specify the days and hours:
Are you willing to work overtime as necessary? SelectYesNo
Are you employed now? SelectYesNo Date you can start Hourly Rate desired
Have you ever been employed by Karsten Interior Services? SelectYesNo If yes, when?
Is there anything that would prevent you from performing in a reasonable and safe manner any of the activities involved in the position for which you have applied? SelectYesNo If yes, explain:
Federal laws require that employers hire only individuals who are authorized to be lawfully employed in the United States. In accordance with such laws, all offers of employment are subject to verification of the applicant’s identity and employment authorization, and it will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization upon employment.
Are you legally authorized to work in the United States? SelectYes No
State name(s) of any relative(s) that are employed with our company and your relationship to them:
Please write the date you completed the training and received a certificate for below fields.
OSHA 10 Date Issued:
OSHA 30 Date Issued:
Basic Plus Card Exp:
You must be oriented by a Karsten Interior Service’s Safety Team before going to work on any job site.
Pre-Employment Statement: (Please read carefully and sign the statement below)
I understand and agree that:
The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification of refusal of employment, or, if employed, termination from Karsten Interior Services, L.P.’s (Company) employ.
Any offer of employment I may receive from the Company is contingent upon my successful completion of the Company’s total pre-employment screening process, including the Company’s receipt of references that it considers satisfactory, and my satisfactory completion of any post-offer, pre-employment medical examination or testing that the Company may require. I hereby agree that the results of any medical exam, test or records may be disclosed to the Company.
As a condition of employment, I may be required to undergo and successfully pass a screening for alcohol and/or drugs. I hereby consent to allowing disclosure to the Company of the results of any alcohol or drug screening that I may be required to undergo.
In processing my application for employment, the Company may verify all the information provided by me, or may procure or have prepared a consumer or an investigative consumer report for this purpose concerning my prior employment, military record, education, character, general reputation, personal characteristics, criminal record, medical record, driving record and mode of living. I understand that, upon written request to the Company, I will be informed whether an investigative consumer report was requested, and will be given full information as to the nature and scope of this investigation.
I authorize all of my present and former employers and those individuals I have listed as personal references to furnish information about my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, and hereby release them from any and all liability for damages arising from furnishing the requested information.
I the undersigned hereby authorize deductions from my payroll check to pay for various items. Such personal charges may include, but are not limited to, any of the following:
Hard Hats/Safety Glasses
Company paid travel charges not accounted for by the individual (over 30 days old)
Unauthorized expenses charged to Karsten Interior Services, L.P.
Damage of company property
If medical treatment is needed for an injury on the job site, I will immediately report to my supervisor and keep all appointments with doctors. I agree to bring any medical status reports to the office within 24 hours of each doctor visit and to keep the office informed of all medical treatment received by doctors and any canceled appointments.
In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of the Company, and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either the Company or myself. I further understand that no manager or representative of the Company has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to the foregoing. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me.
I understand the nature of the construction industry requires me to drive to different job sites and those job sites may or may not be located within the city limits and may require traveling.
Health Insurance Laws may require you to keep us informed of changes in your marital and dependent status. Please advise human resources of all changes.
Martal Status: SelectSingleMarried
If married, Spouse Name: # of children
Race and Ethnicity: SelectHispanicWhiteBlack or African-AmericanAsianNative Hawaiian or Other Pacific IslanderAmerican Indian or Alaskan NativeTwo or More RacesOther
Karsten Interior Services will supply, upon my approved employment, a hardhat, safety glasses, vest, gloves, and sleeves protection. If this equipment is lost by the employee, I authorize ten dollars deduction per week for each replacement item until the Company has been reimbursed full replacement value. There will be no charge for replacement PPE issued when worn out or damaged PPE is presented for replacement. Upon termination of employment with Karsten Interior Services I will return all equipment that has been checked out to my responsibility, or I may have withheld full replacement value from my paycheck. This may result in no earnings and a Form 1099 issued to the IRS if my earned wages do not cover the replacement cost of company property.
Karsten Interior Services pays all employees by electronic funds via a Direct Deposit to your bank account. There are no fees to the employee for this convenience. If you currently do not have a bank account, please contact Human Resources and we will assist you in obtaining one.
I hereby authorize Karsten Interior Services, hereafter called “Company”, to initiate credit entries and initiate, if necessary, debit entries and adjustments for any credit entries in error to the account(s) listed below and the depository listed below, herein called “Depository”, to credit and/or debit the same to such account.
Karsten Interior Services offers direct deposit of employee paychecks to the bank and account of the employee’s choice. To enroll, change or cancel direct deposit the employee must complete the Karsten Interior Services Authorization Agreement for Automatic Deposits form. The completed form is then submitted to the Human Resources Department along with a bank form or VOIDED check for processing.
Bank Account Number:
Bank ABA Routing Number:
A hand written copy will not be acceptable
A temporary check with no pre-printed information will not be acceptable
The employee’s name must be on the account
Notify the Human Resources department if you close or change your bank account. Generally it takes 1-2 pay periods for new enrollments or changes to existing account information to take effect.
I have received information that informs me how to get health care under my employer’s workers’ compensation insurance.
If I am hurt on the job and live in a service area described in this packet, I understand that:
I must choose a treating doctor from the list of doctors in the network. Or, I may ask my HMO primary care physician to agree to serve as my treating doctor. If I select my HMO primary care physician as my treating doctor, I will call Texas Mutual Insurance Company at (844) 867-2338 to notify them of my choice.
I must go to my treating doctor for all health care for my injury. If I need a specialist, my treating doctor will refer me to a specialist. If I need emergency care, I may go anywhere.
Texas Mutual will pay the treating doctor and other network providers for the treatment for my compensable injury.
I may have to pay the bill if I get health care from someone other than a network doctor without prior network approval.
Knowingly making a false workers’ compensation claim may lead to a criminal investigation that could result in criminal penalties such as fines and imprisonment.
I live at:
Name of employer:
Name of network: WorkWell, TX
This document provides direction for all Karsten Interior Services employees using stilts to perform work on all construction projects.
STILT PRE- PLANNING:
NO walking on stilts until work area has been cleaned and inspected
Daily Stilt inspections must be performed before use by user ( straps, springs , feet )
Caution Tape off an area if possible ( if job allows )
Signs must be posted STILT WALKERS WORKING IN AREA
Laborer and/or spotter to clean work area) – trash out, pick up mud or help with material.
STILT WALKING PROCEDURES:
Inspect stilts thoroughly BEFORE USE, making sure that the stilts are free of any signs of damage, that there is no excessive wear at the connection points and that all bolts are tight. Be sure to inspect the entire strut tube, straps, springs and feet.
Replace any damaged or excessively worn stilt components straps, feet, springs, screws and bolts before daily use.
Keep stilts adjusted properly - you must remove stilts to adjust them unless assisted by another person.
Remove anything from the soles which could cause loss of traction.
Fasten the upper leg strap first when putting on the stilts.
Keep all straps tightly fastened and secured.
Kneepads must be worn at all times while walking or working with stilts.
Walk only on clean and level hard surfaces.
Employees are responsible for their own stilts. DO NOT share or use another coworkers stilts.
Walk forward only, making a U- turn to reverse your direction.
Use laborer/spotter assistance when retrieving material from floor level.
Stay at least 10 feet away from any opening to the floor below or to the exterior of the building.
Any waste produced and material dropped by stilt workers must be promptly cleared away by laborer/spotter
Remove stilts when climbing or descending stairs.
Disconnect upper leg strap last when removing stilts.
Do not jump on or off stilts - must use ladder, scaffold, material stack or wall for support.
REMEMBER! Any employee in violation of the following rules are subject to disciplinary action up to and including termination.
The purpose of this policy is to establish a procedure to reduce injuries directly or indirectly related to using mobile devices on worksites. There are many hazards associated with using mobile devices on a worksite. It can distract users from the hazards associated with their work tasks and their surroundings, and it can distract other workers in the area.
Restricting the use of mobile devices on a worksite will increase the level of concentration of workers. If workers are more focused on their job, the quality of their work will improve and the number of incidents associated with the distractions caused by using mobile devices will decrease.
Karsten Interior Services will not be liable for the loss of Mobil devices brought to the workplace. This policy applies to all workers and visitors entering the worksite.
Types of Mobile Devices
This policy includes all mobile devices including, but not limited to, cell phones, tablets, MP3 players, and iPods.
Only those individuals authorized by Management are permitted to use mobile devices on worksites. The use of mobile devices on site is prohibited unless expressed consent is granted by Supervisor. This includes talking, texting, emailing, playing games, social media etc.
The use of mobile devices is not permitted while operating any mobile material handling equipment, while working on any aerial work platforms, or while performing activities that require your full attention.
The use of mobile devices is not permitted while attending safety meetings or while receiving safety-related information such as a safety talk.
Supervisors should make every reasonable effort to avoid using their mobile device or making calls while directing activities on the worksite.
Mobile devices should be turned off or set to silent or vibrate mode when working. The ringer may startle you or someone else in the area.
The use of mobile devices is not permitted around explosive or flammable atmospheres or while decanting or working with flammable or combustible material.
If an urgent family matter requires a worker to use their mobile device, the worker must coordinate with the Foreman so that the communication can be done in a safe manner.
Workers are permitted to use mobile devices when they are in the following designated safe areas:
The company’s break room, lunch room, site trailer, office or any area as defined safe by the GC or Supervisor per job.
Supervisors are permitted to use mobile devices in the construction trailer, in the site office, or at one of the designated safe areas listed above, provided it is away from general work activities.
Supervisors are permitted to use mobile devices on site when expressed consent is provided by Management.
Video or audio recording devices
The use of camera or other video or audio recording-capable devices on jobsites is prohibited without the express prior permission of senior management and of the person(s) subject to recording.
Consequences for Violators
Employees violating this policy will be subject to discipline, up to and including termination of employment.
The undersigned employee acknowledges that he or she had read the mobile device on Worksite policy and agrees to comply with all the terms of the policy.
Karsten Interior Services is in accordance with The Patient Protection Affordable Care Act (PPACA) by offering affordable health insurance for individual employee coverage. Although it is your choice whether to accept insurance through Karsten Interior Services or through the Healthcare Market Exchange, you will be responsible for your own health coverage and that of your family if you elect to not enroll. Reporting requirements are now mandatory for the 2015 year and moving forward. Whether or not an employee obtains health insurance through Karsten Interior Services will be reported to the IRS each January for the previous year of employment.
The IRS has approved the use of electronic W-2 statements. Instead of paper copy, Employees may choose to receive their W-2 statement electronically. The advantages of this option are:
Quicker access to your tax information
The form is available on any device with internet connection
It is available to print or re-print for 2 years
By signing this form, you are consenting to receive your W-2 by electronic means only; a paper copy will not be provided to you. This consent remains in effect indefinitely or until you inform the payer that you wish to revoke the consent. Simply notify the payer in writing, or email, that you would prefer a paper copy instead of the electronic version.
If you withdraw your consent after the W-2 has posted to the secure website, you can request a paper copy be mailed to you with the contact listed below.
Please provide/review the following information to ensure proper receipt of the website address, unique login information, and password that will be needed to access your electronic W-2. Keep your employer informed of any changes that occur during the year as they will need accurate information to notify you when your W-2 is available. Please note that your W-2 will not be emailed to you, simply the required information needed to access it.
To verify you will be able to access and print the form, go to https://efile.aatrix.com/STL032 and print the W-2 sample form. Your employer will notify you when your electronic Form W-2 is available and will provide the password you will need to access it.
With this signature, I consent to receive my W-2 electronically from this date forward until I withdraw the consent in writing:
The IRS has approved the use of electronic 1095 statements. Instead of paper copy, Employees may choose to receive their 1095 statement electronically. The advantages of this option are:
By signing this form, you are consenting to receive your 1095 by electronic means only; a paper copy will not be provided to you. This consent remains in effect indefinitely or until you inform the payer that you wish to revoke the consent. Simply notify the payer in writing, or email, that you would prefer a paper copy instead of the electronic version.
If you withdraw your consent after the 1095 has posted to the secure website, you can request a paper copy be mailed to you with the contact listed below.
Please provide/review the following information to ensure proper receipt of the website address, unique login information, and password that will be needed to access your electronic 1095. Keep your employer informed of any changes that occur during the year as they will need accurate information to notify you when your 1095 is available. Please note that your 1095 will not be emailed to you, simply the required information needed to access it.
To verify you will be able to access and print the form, go to https://efile.aatrix.com/STL032 and print the 1095 sample form. Your employer will notify you when your electronic Form 1095 is available and will provide the password you will need to access it.
With this signature, I consent to receive my 1095 electronically from this date forward until I withdraw the consent in writing:
It is Karsten Interior Services’ policy that the employee’s signature or initials must be on each timesheet for the employee to be paid for that day. The employee should verify that the time written in and out by the Foreman is correct.
All employees must find the Foreman and sign in each day. It is the employees responsibility to sign in, not the Foreman’s.
If no Foreman is on the job call your Superintendent at the office, to report the start time and finish time each day.
Notify your foreman or superintendent if you will be absent or late. If we do not hear from you for three business days it is considered job abandonment which means you voluntarily resign your position.
Any employee with problems on their checks or sign in sheets should try to resolve the problem with their Foreman. If the problem cannot be resolved then the employee and Foreman should talk to their Superintendent. If this does not resolve the problem, the employee should talk to the Payroll Department.
Hours vary at different job sites. If you are late or have excessive absences you will be addressed and documented accordingly. Poor attendance and excessive tardiness are disruptive. Either may lead to disciplinary action, up to and including termination of employment.
One fifteen-minute break at 9:30am to 9:45am.
Thirty minutes lunch from 12:00 to 12:30.
Pay day is Friday and is deposited directly into the employee’s bank account.
Karsten Interior Services does not guarantee an 8 hour day or a 40 hour work week.
Failure to follow the above procedures could result in a negative job performance evaluation, suspension, and/or termination.
Coverage: Karsten Interior Services, L.P. has workers’ compensation insurance coverage from Texas Mutual Insurance Company to protect you in the event of work-related injury or illness. Texas Mutual Insurance Company will handle any injuries or illnesses. An employee or a person acting on the employee’s behalf must notify the employer of an injury or illness immediately.
Employee Assistance: The Commission provides free information about how to file a workers’ compensation claim. Commission staff will explain your rights and responsibilities under the Workers’ Compensation Act and assist in resolving disputes about a claim. You can obtain this assistance by contacting your local Commission field office.
Safety Hotline: The Commission has established a 24-hour toll-free telephone number for reporting unsafe conditions in the workplace that may violate occupational health and safety laws. Employers are prohibited by law from suspending, terminating, or discriminating against any employee because he or she in good faith reports an alleged occupational health or safety violation. Contact the Division of Workers’ Health and Safety.
Notice to New Employee
“You may elect to retain your common law right of action if, no later than five days after you begin employment or within five days after receiving written notice from the employer that the employer has obtained coverage, you notify your employer in writing that you wish to retain your common law right to recover damages for personal injury. If you elect to retain your common law right of action, you cannot obtain workers’ compensation income or medical benefits if you are injured.”
At Karsten Interior Services, L.P., we conduct our business with a telephone system designed to provide top quality service for both customers and employees. If it is necessary to make a personal call, please keep it as brief as possible and always away from customers; preferably on your breaks, lunch or outside of work hours. If you need to make a personal long distance call, you must call collect or charge it to your home telephone number.
Email and Computer System Policy
Karsten Interior Service’s email, Internet access and computer systems are for Company business. Employees may use Karsten Interior Services computers, Email and Internet access during their own time, lunches, breaks, outside of work hours. The company prohibits the display or transmission of sexually explicit images, messages, cartoons, as well as the use of ethnic slurs, racial epithets, or anything that may be construed as harassment. Usage of computer games or any other form of electronic entertainment software during work hours is prohibited.
In an effort to protect the integrity of our systems, all software used on Karsten Interior Services’ computers must be registered with the Company. Personal or downloaded software may only be installed after written authorization has been received. A complete virus check of all such software must be made immediately before it is installed on any company computer. A virus check must be made of any disk originating or used on any computer outside Karsten Interior Services, L.P., prior to use on a company computer. Copying or transfer of company owned software may be done only with the written authorization of the Company.
Karsten Interior Services Access to Voice Mail, Email and Computer Systems
Be aware that you have no personal privacy rights in any mail and/or message created, received, or sent from Karsten Interior Service’s voice mail, email or computer system. Karsten Interior Services reserves the right to enter your voice mail, email, and computer system for business purposes. This is to ensure that Karsten Interior Services policies are being followed and to access information when you are not available. You are required to make your system passwords available to your supervisor.
Karsten Interior Services Employment Handbook This Acknowledgement of Receipt must be completed within two weeks of receiving the handbook. Submit the completed acknowledgement to:
I, acknowledge that I have received the Karsten Interior Services Handbook. Furthermore I acknowledge that this handbook is neither a contract of employment nor a legal document. I acknowledge that it is my responsibility to read and comply with the policies contained in this handbook. I acknowledge that my employment relationship with Karsten Interior Services is voluntary and that there is no specified length of employment. Accordingly either Karsten Interior Services or I may terminate the employment relationship at will at any time, with or without cause, so long as there is no violation of applicable federal or state law.
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Application For Employment
Agree & Sign