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NOTICE: TO ALL APPLICANTS FOR EMPLOYMENT As part of our selection and hiring process, our companies engage in pre-employment drug testing of all gualified applicants for employment as allowed by law. These tests are highly sophisticated and capable of detecting trace amounts of various controlled substances and illegal drugi. lf you are currently using illegal drugs, please do not waste your time and ours by applying for work here. Due to the daily inherent dangers along with United States Department of Transportation (UsDoT) regulation, our high voltage construction profession requires a highly trained, super safe, competent, and skilled work force with a high degree of concentration, training, job knowledge, skills, and abilities, and is a critical job specialty. Therefore, this is a zero tolerance policy. Test results which indicate the presence of illegal drugs in your body will negate further hiring consideration as allowed by law. uJl1ffi=a

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Page 1: by law. testsredrockpower.com/wp-content/uploads/2017/09/Red... · IMPORTANT INSTRUCTIONS FOR FILLING OUT AND TURNING IN YOUR APPLICATION You may mail your application to: Red Rock

NOTICE: TO ALL APPLICANTS FOR EMPLOYMENT

As part of our selection and hiring process, our companies engage

in pre-employment drug testing of all gualified applicants foremployment as allowed by law. These tests are highlysophisticated and capable of detecting trace amounts of variouscontrolled substances and illegal drugi. lf you are currently usingillegal drugs, please do not waste your time and ours by applyingfor work here.

Due to the daily inherent dangers along with United States

Department of Transportation (UsDoT) regulation, our highvoltage construction profession requires a highly trained, supersafe, competent, and skilled work force with a high degree ofconcentration, training, job knowledge, skills, and abilities, and is a

critical job specialty. Therefore, this is a zero tolerance policy.

Test results which indicate the presence of illegal drugs in yourbody will negate further hiring consideration as allowed by law.

uJl1ffi=a

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DOT OFFICE OF DRUG AND ALCOHOL POLICY AND COMPTIANCE NOTICE

oRecently, the Department of Justice (DOJ) issued guidelines for Federal prosecutors instates that have enacted laws authorizing the use of "medical marijuana.,,

We have had several inquiries about whether the DoJ advice to Federal prosecutorsregarding pursuing criminal cases will have an impact upon the Department ofTransportation's longstanding regulation about the use of marijuana by safety-sensitivetransportation employees - pilots, school bus drivers, truck drivers, train engineers,subway operators, aircraft maintenance personnel, transit fire-armed securitypersonnel, ship captains, and pipeline emergency response personnel, among others.

We want to make it perfectly clear that the DOJ guidllines will have no bearing on theDepartment of Transportation's regulated drug testing program. We will not changeour regulated drug testing program based upon these guidelines to Federal prosecutors.

The Department of Transportation's Drug and Alcohol Testing Regulation - 49 CFR part4o, at 40.151(e) - does not authorize "medical marijuana" under a state law to be avalid medical explanation for a transportation employee's positive drug test result.

That section states:

S 40.151 What are MROs prohibited from doing as part of the verification process?As an MRO, you are prohibited from doing the following as part of the verificaiion

process:(e) You must not veri$r a test negative based on information that a physician recommendedthat the employee use a drug listed in Schedule I of the Controlled Su6stances Act. (e.g.,under a state law that purports to authorize such recommendations, such as the ,,medifimarijuana" Iaws that some states have adopted.)

Therefore, Medical Review Officers will not verify a drug test as negative based uponinformation that a physician recommended that the employee use ,,medical

marijuana." Please note that marijuana remains a drug listed in Schedule I of theControlled Substances Act. lt remains unacceptable for any safety-sensitive employeesubject to drug testing under the Department of Transportation,s drug testingregulations to use marijuana.

We want to assure the traveling public that our transportation system is the safest it canpossibly be.

Jim L. SwartDirectorOffice of the Secretary of TransportationOffice of Drug and Alcohol

Policy and ComplianceDepartment of TransportationOctober 22,2OO9

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IMPORTANT INSTRUCTIONS FOR FILLING OUT AND TURNING IN YOUR APPLICATION

You may mail your application to:

Red Rock Power, Inc.

ATTN: Human Relations Manager

P.O. Box 358

Great Falls, MT 59403-0358

You may fax it to (406) 761-5047. If you choose to fax in your application, you may wish to call me at

(406) 781-8033 to verify it made it in. We are not responsible for incomplete faxed applications.

Please ensure your application is filled out completely. Make sure it is legible and easy to read.

Ensure you include a copy of your driving record as required by Title 49 Transportation of the Code of

Federal Regulations. Applications that do not contain a valid driving record will not be processed.

If you are from Montana, you may request a copy of your driving record online at:

https://app. mt.gov/dojdrs/

If you are from another state, contact your Department of Motor Vehicle or appropriate licensing

records division from your state.

NOTE: Applications sent in without a current and complete driving record will be considered

incomplete and not be processed.

If you have any questions, please contact me at (406) 781-8033 during the business hours of Monday

- Friday, 8:30AM - 3:00PM Mountain Time.

Loren Skoyen

Director of Operations, Safety & Human Relations

Red Rock Power, Inc.

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RED ROCK POWER, INC. P.O. Box 358 - Great Falls, Montana USA 59403-0358

Attention: Human Relations Manager Phone(406)781-8033

STANDARD EMPLOYMENT APPLICATION FORM

Information for Applicants

1. Red Rock Power Incorporated accepts applications only for open positions. Applications are maintained on file for a period of one year for future positions once a position applied for has been filled.

2. All candidates must complete an application before a job offer can be made. A resume submitted to Red Rock Power, Inc.,does not constitute an "application for employment." All resumes and other such employment letters will be consideredunsolicited mail, except when attached to the completed application form.

3. If you are applying for a position which requires a valid Montana driver's license, you must attach a copy of your motor vehicledriving record to this application. Such a copy will be required prior to your being officially hired. A current copy of that reportwill also be required annually while you are employed by Red Rock Power, Inc. All employees who either operate a Red Rockpower, Inc., vehicle, or could reasonably be required to operate a Red Rock Power, Inc., vehicle, must have a valid Montanacommercial driver's license and a driving record which is acceptable and insurable by Red Rock Power, lncorporated'sinsurance carrier at standard group rates, and must maintain such a record throughout their employment with Red RockPower, Inc.

Applicant's Statement

I understand that Red Rock Power, Incorporated may verify all data given in my application for employment, related papers, or in oral interviews. I authorize such investigation and the giving or receiving of any such information. I understand that any falsification of this data, any material misrepresentation, or any deliberate omission of a fact may subject me to immediate dismissal. I certify that all the employment materials I have submitted are true and correct. Finally, I consent to the release of all employment information of whatever type by my previous employers listed in this application, and in consideration of any previous employers' agreement to furnish information regarding my employment history with their firms, I hereby release and hold harmless such employers and their employees from any claim of liability of whatever nature which might arise out of their release of employment information about me. I further waive and give up any claim or action which I might have against them which could arise out of the release of information about me.

If the position I am applying for requires a valid Montana commercial driver's license, I understand that, should my driving record be unacceptable to Red Rock Power, lncorporated's insurance carrier, my employment may be terminated.

I understand that Red Rock Power Incorporated requires a post-employment physical examination to ascertain that job applicants have the requisite capabilities for jobs. Employer will, as a condition of processing applicant's employment application, require pre­employment drug and alcohol screening. Results of drug screening will be maintained in a confidential file. A condition of employment for any applicant will be urinalysis testing for the presence of controlled substances or alcohol. Any positive test results (other than those prescribed by a doctor and suitably documented) will disqualify the applicant for employment with Red Rock Power, Inc. All employees of Red Rock Power Incorporated participate in the company's ongoing random drug testing program.

I further understand that no employment contract is being offered, that my employment is for no definite period of time, and that Red Rock Power Inc., can change wages, benefits, and conditions at any time, and I understand that a condition of employment is the agreement that the policies and benefits of employment may be changed unilaterally and that no vested rights in preexisting rights or benefits shall exist. Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift work, or a work schedule other than Monday through Friday, as well as holidays. I further understand that Red Rock Power, Inc., will observe all labor agreements which are in effect.

I understand that I am required to abide by all rules, regulations, and policies of Red Rock Power, Incorporated.

Signature of Applicant Date

An Equal Opportunity Employer

We are an equal opportunity employer. We do not and will not discriminate on the basis of race, religion, national origin, sex, age, disability, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

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Red Rock Power, lnc.Employment Application

Page 2

Please read carefully and complete by printing in ink or typing clearly and legibly.Last Name

How were youto Red Rock Power?

ZIP code

Date of application

Social security no.

Telephone noHome:Work:

(,Resumeor letter

GENERAL INFORMATIONlf you are under 18 years of age, can you provide required proof of your eligibility to work? tr Yes tl NoHave you ever filed an application with Red Rock Power, lnc., before? tr yes tr No

lf yes, give date:Have you ever been employed with Red Rock Power, lnc., before? tr yes tl No

If yes, give date:Are you currently employed? trYestrNoMay we contact your present employer? tr Yes fl NoAre you prevented from lawfully becoming employed in this country because ofVisa or lmmigration Status? tr yes tr No(Proof of citizenship or immigration status will be required upon employment)

On what date would you be available for work?Are you able to work: EI Full Time E Part Time E Snift WorX tr TemporaryAre you currently on "lay-off' status and subject to recall? trYestrNoCan you travel if a job requires it? tr Yes fl NoHave you been convicted of a felony within the last 10 years? tl yes tl No(Conviction will not necessarily disqualify an applicant for employment)

lf Yes, please explain:

Can you work overtime if necessary? n Yes tl NoAre you aware of any reason why you may not be granted a commercial driver's License?Please explain: tr yes tr No

Have you ever been denied government security clearance? trYesENoAre you related, directly or through marriage, however remotely, to anRed Rock Power, lnc., employee, or to any member of it's Board of Directors? tr yes tr No(RRP's Anti Nepotism Policy prohibits supervision of an employee by a member of the employee's family)If so,jn what way?Do you have a valid COMMERCIAL driver's license?

Current license number: State:tr Yes Notr

Have you received a copy of the job description? trYestrNoAre you aware of any reason why you could not perform each and every requirementof the job description in an "above average" manner? tr Yes Nou

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Red Rock Power, lnc.Employment Application

Page 3

Educational HistoryCircle hiqhest

School name

High school

Technical/trade (after highschool)

College (list all attended)

Other education/train ing

Outside Activities(Exclude those indicating race, color, religion, sex, nationalorigin, age, handicap, Vietnam-era, or Gulf War-era vet status)Professional memberships, certificates, or licenses held

Past and present civic or cultural activities - include offices held

Principal hobbies

SkillsTo be completed by applicant Type equ ip me nUm ach i n es operated:

Graduated Line School E Yes E No

If yes, please list school

Qualified Climber? E Yes fl No

Years climbing:

Cu rrent certifications:E Pole Top Rescue I Bucket Rescue I First Aid

tr CPR [] Flagging I Live Line Hot Work

Please list other skills and/or experience you have acquired

Apprenticesh ip I nformation :

Completed an apprenticeship program? fl Yes I No

Digger Derrick lpusk I Yes E No

BucketTruck EYes ENo

Backhoe EYes ENo

Apprenticeship Name:

List other equipmenUmachinery or skills:

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Red Rock Power, lnc.Em ployment Application

Page 4

Employment Record

lf more rs requrLast or present companybusinessStreet address Phone no.

State

Supervisor's name and title

Base salary

Reason for leaving

CompanybusinessStreet Address

State

Supervisor's name and title

Base salary

Reason for leaving

CompanybusinessStreet Address

continue on a sheet. You attach resume, butType of Title or job classification

Brief description of job duties

ZIP code

Phone no

Type of Title or job classification

Phone no. Brief description of job duties

ZIP code

Phone no.

Type of Title or job classification

Phone no. Brief description of job duties

ZIP code

Phone no.

ication as well.

City

City

City State

Supervisor's name and title

Base salary

Reason for leaving

U,S, Military Record

Starting with present or most recent, list all previous employers, lnclude self-employment and summer and parttime jobs-

Branch of service From: To:

Present military affiliation.

None Reserve (active ReserveKinds of training and duty while in seruice

inactive Guard active Guard inactive

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Red Rock Power, lnc.Employment Application

Page 5

Profess i o n a I Nllo rk Refe rencesList two past supervisors and one person who is not related to you who have knowledge of your qualifications for the

ition for which vou areOccupation

May we contact your present employer? EYes

ENo

Address(street, city, state, zip code)

Wage or salary desired

Date available

Commentslf any of your educational or employment records are under other than the above name, please provide other names.

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INSTRUCTIONS FOR SAFETY PERFORMANCE HISTORY RECORDS REQUEST FORM

On the next page you must completely fill out section 1 in giving us permission to contact your

previous employer for safety performance history.

Prospective Employer:

Street:

City, State, Zip:

Red Rock Power, Inc.

P.O. Box 358

Attn: Loren Skoyen Telephone (406) 781-8033

Great Falls, MT 59403-0358

Prospective employer's confidential fax number: (406) 761-5047

Prospective employer's confidential email address: [email protected]

Sign and date the section and the rest will be filled out by your previous employer when we send it to

them.

INSTRUCTIONS FOR PREVIOUS PRE-EMPLOYEE ALCOHOL AND ORIG TEST STATEMENT

Complete this form by printing you first name, middle initial, and last name. Read statement 1 and

answer it. If you must, read statement 2 and answer it, only if you must providing proof that you have

successfully completed the USDOT substance abuse program (SAP), return to work and follow-up

testing requirements in full.

Sign and date the form. Have a witness sign and date the form.

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SIDE 1 SAFETY PERFORMANCE HISTORY RECORDS REQUESTRECIPIENT EMPLOYER: The individual identified in SECTION 1 below has indicated that you employ(ed) or use(d) him/her withinthe last 3 years in a position that involved the operation of a commercial motor vehicle and/or that was subject to U.S. Departmentof Transportation (DOT)-regulated drug and alcohol testing.

ln accordance with 49 CFR SS40.25 and 391.23, we are hereby requesting that you supply us with the Safety Performance Historyof this individual. Under DOT rule $391.23(g), you must respond to this inquiry within 30 days of receipt.

Please complete SECTIONS 2 through 4 (as applicable) and return to the prospective employer shown in SECTION 1.

APPLIGANT: Complele SECTION 1 and submit to prospective employer.

LROSPECTIVE EMPLOYER: Complete SECTION 5a and send forrn to currenVprevious employer. Upon receipt of completedform, complete SECTION 5b and retain.

TO BE COMPLETED BY PROSPECTIVE EMPLOYEE

l, (Print Name)' Soclat SecurltY ftttrnrOer

hereby authorize:Date of Birth

Previous Employer: Email:

Street: Telephone:

City, State, Zio: Fax No.:

to release and forward the information requested by section 4 of this document concerning my Alcohol and Controlled Substances Testingrecords within the previous 3 years from

-

.

(date of employment application)

To:

Prospective Employer:

Attention:

Street:

City, State, Zip:

Telephone:

ln compliance with $40.25(9) and 391.23(h), release of this information must be made in a written form that ensures confidentiality, such asfax, email, or letter.

Prospective employer's confidential fax number:

Prospective employer's confidential email address:

Applicant's Signature

TO BE COMPLETED BY PREVIOUS EMPLOYER

EMPLOYMENT VERIFICATION

The applicant named above was or is employed or used by us. Yes n No trEmployed as (ob title)

Didhe/shedriveamotorvehicleforyou? Yesn Non lf yes,whattype? StraightTruckn Tractor-Semitrailertr BusECargo Tank E Doublesffriples n Other (Specify)

lf there is no safety performance history to report, check here D and return. Otherwise, complete Sections 3 and 4 on SIDE 2before returning"

O Copyright 2008 J. J. KELLER & ASSOCIATES, lNC.Neenah, Wl. USA. (800) 327-6868

850-F {Rev. 6/08} 9652

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SIDE 2 Em Name: Date:TO BE COMPLETED BY PREVIOUS EMPLOYER

ACCIDENT HISTORYcomplete the following for any accidents included on your.accident register ($3g0.15(b)) that involved the appticant in the3 years prior to the application date shown on SIDE 1 or check here I if tfiere is'io accideni register data for this driver.

Date Location No. of lnjuries No. of Fatalities Hazmat Spill1.

2,-....._.-_-._-3._*--Please provide information concerning any other commercial motor vehicle accidents involving the applicant that were reportedto governmenl agencies or insurers or retained under internal company policies:

TO BE COMPLETED BY PHEVIOUS EMPLOYERDRUG AND ALCOHOL HISTORY

lf applicant was not subject to Dor testing requirements under 49 cFR Part 40 while employed by you, ptease check here l-l and return.Applicant was subject to DOT testing requirements from to---_-.

[,:Hi,#:Jiffi,:lX1',".":itr]:; anv required Dor drug or alcoholtestins inrormation you obtained rrom other emptoyers in the o years

Within the past 3 years from the application date shown on SIDE 1: yES NO1' Has this person violated any of the drug and/or alcohol prohibitions under 49 cFH part 40 or subpart B of part 382, including, I tr

' An alcohol test with a result of 0.04 or higher alcohol concentration.' A controlled substances test result of poiitive, adulterated, or substituted.' A refusal to submit toe rand6m, post-bccident,.reasonable:srsfii"ion, or follow-up controlled substances or alcohol test.' Alcohol use while performing or within 4 hours before pertormiril iafety-sensitiv;l;;"ilo;;. Alcohol use after an accident, in violation of g3g2.303.' controlled substances use while on duty, exiept as allowed under gsg2.213.

2' lf this porson violated a DoT drug and/or alcohol prohibition, did he/she failto begin or complete a rehabilitation program [} Iprescribed by a substance Abuse Professional(sAP)? lf rehabilitation was requirlo nutyorioo not know if he/she beganor completed such a program, check here [.3' lf this person successfully completed a SAP's rehabilitation referral and remained in your employ, did he/shesubsequently have an alcohol test result of 0.04 or greater, a verifieJ fositive orug te'si, ;iieiusar to be tested? ntrr

N/A

l

TO BE COMPLETED BY PROSPECTIVE EMPLOYEiThisformwas(checkone)Iraxeotopreviousemployern

Subsequent attempts to contact previous employer (g391.23(c)(1)):

TO BE COMPLETED BY PROSPECTIVE EMPLOYERComplete below when information is obtained.

Method: f] ru* l-l urir fl emair fI r","o*l-l o,n",

O Copyright 200-8 J. J. KELLEB & ASSOCIATES, tNC.Neenah, W, . USA. (800) 327-6968 8s0-F (Retr 6i08) 9652

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PREVIOUS PRE.EMPTOYMENT EMPTOYEE ALCOHOT AND DRUG TEST STATEMENT

Section 40.25(j) As the employer, you must also ask the employee whether he or she has

tested positive, or refules to test, on any pre-employment drug or alcohol testadministered by an employer to which the employee applied for, but did not obtain,safety sensative transportation work covered by DOT agency drug and alcohol testingrules during the past two years. lf the employee admits that he or she had a positive testor refusal to test, you must not use employee to perform safety sensative functions for you,until and unless the employee documents successful completion of the return-to-dutyprocess. (see Sec. 40.25(bX5) and (e)).

PROSPECTIVE EMPLOYEE

Name:(Print) First Name, Middle lnitial Last Name

The prospective employee is required by Sec. 40.25(j) to respond to the following questions:

1. Have you tested positive, or refused to test, on any pre-employment drug or alcohol testadministered by an employer to which you applied for, but did not obtain, safety sensativetransportation work covered by DOT agency drug and alcohol testing rules during the past

two years?

Check one: YES E*o2. lf you answered yes, can you provide/obtain proof that you have successfully completedthe DOT SAP return-to-work and follow-up testing requirements?

Check one: YES E*o

I certify that the information provided on this document is complete, accurate, true, and correct.

Signature:

Witness:

Date:

Date:(Signature)