are covered by state workers’ compensation statutes, and to avoid the circumvention of such statutes, I hereby waive and
forever release any rights I might have to make claims or bring suit against CoAdvantage or its other clients or customers for
damages based upon injuries which are covered under such workers’ compensation statutes.
Notice to Texas Employees: 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 CoAdvantage or your Employer (as applicable) 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.
Drug Testing: I understand that my Employer may now have, or may later establish, a drug-free workplace or a drug and/or
alcohol testing program consistent with applicable federal, state, or local law. I understand that, pursuant to the Employer’s
policy and federal, state, or local law, I may, as a condition of hire or continued employment, be subject to urinalysis and/
or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. I also
understand that I may be subject to an alcohol and/or drug test before any treatment of a work-related accident or injury and
if I refuse to be tested or test positive, I may be denied all of my Workers’ Compensation medical and indemnity benefits. I
understand that refusal to submit to an alcohol and/or drug test may be considered a positive test result and/or grounds for
termination.
Background Check: I understand that all information contained in this employee packet is subject to verification. In the
event my Employer requires a complete background and/or credit check, I authorize and consent, to the extent permitted by
federal, state and local law, to allow my Employer, CoAdvantage or their respective agent(s) to obtain information including,
but not limited to, motor vehicle reports (driving records), credit history, employment or educational references, criminal history
and any other information concerning me.
Anti-Harassment Reporting: I understand that CoAdvantage and my Employer follow the policy of a harassment-free work
environment and I will conduct myself accordingly. I further understand and agree to report to my Employer or CoAdvantage
incidents of harassment against myself or witnessed co-worker harassment. Complaints of harassment may be reported to
CoAdvantage at (877) 535-5226.
Authorization Release: I hereby authorize any party or agency contacted by my Employer, CoAdvantage or their respective
agent(s) to furnish information requested. I understand that I may be required to complete additional releases authorizing my
Employer or its agent(s) to investigate all statements contained in this or any other employment-related documents. I hereby
release, discharge and hold harmless, to the extent permitted by federal, state and local law, my Employer, CoAdvantage,
their respective agent(s) and any party delivering information to them pursuant to this authorization from any liabilities, claims,
charges or causes of action that I may have as a result of the gathering, delivery or disclosure of any requested information.
Acknowledgment for Participation in Client-Sponsored Benefit Plans: If my Employer notifies CoAdvantage that I am
participating in a client-sponsored benefit plan (a benefit plan sponsored by my Employer and not by CoAdvantage) then
I authorize CoAdvantage to take payroll deductions in an amount specified by my Employer and to remit such deducted
amounts to my Employer. I acknowledge that CoAdvantage has no discretionary authority over the assets of these benefit
plans and relies solely on information supplied by my Employer.
_________ Part-Time or On-Call Employees Only (Initial if Applicable): I understand and acknowledge that my employment
status with my Employer will be Part-Time and/or On-Call, and there will be no guarantee of how many hours I will be
assigned and/or work in any given week.
Consent to Electronic Signature: I hereby grant to my Employer a limited power of attorney to electronically submit
such information and bind me to any electronic version of any form included as part of the new employee packet that I
have manually completed and signed, but only to the extent permitted by law and only to the extent such form is used in
connection with my co-employment by CoAdvantage and my Employer.
Employee Authorizations & Acknowledgments
