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Application for Employment

PERSONAL INFORMATION

Name
Present Address

DIAMOND PEO OFFERS EQUAL EMPLOYMENT OPPORTUNITIES REGARDLESS OF SEX, AGE, RACE, COLOR, RELIGIOUS CREED, NATIONAL ORIGIN, ANCESTRY, MEDICAL STATUS, MEDICAL CONDITION, PHYSICAL OR MENTAL DISABILITY, PREGNANCY OR SEXUAL ORIENTATION.

EMERGENCY CONTACT

PLEASE REVIEW THE FOLLOWING BEFORE SIGNING THIS APPLICATION FOR EMPLOYMENT

FORMER EMPLOYERS (LIST BELOW THE LAST THREE EMPLOYERS, STARTING WITH THE MOST RECENT ONE)


REFERENCES: NAMES OF THREE PERSONS YOU ARE NOT RELATED TO, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR
Diamond PEO EMPLOYEE ACKNOWLEDGEMENT FOR WORKERS' COMPENSATION PROCEDURES

Diamond PEO is involved with a wide variety of Medical Providers for Workers' Compensation. This helps provide the most timely and suitable, quality medical care in the event of an injury on the job. Diamond PEO requires post-accident drug testing. After an employee is clinically tested and the results are positive, the employee will be terminated.

The following procedures must be followed for all work related injuries and illnesses.
1) Report promptly all work-related injuries to your supervisor. Your supervisor will direct you to the nearest authorized Occupation Medical Provider.
2) If it is a medical emergency, get medical care immediately, then notify your supervisor.
3) Complete a Workers' Compensation packet within 24 hours of the time of injury, including the Injury Incident Report and Post - Accident Drug Testing Policy,
4) Take post injury drug screen at the clinic.
5) After treatment, you must bring back to your supervisor the paperwork given to you at the clinic. This will normally include the Doctor's Report with any Work Restrictions and Documentation that you did take a Drug Test. Understand that in almost every case "Modified Work Will be Offered to You."

Please sign below to indicate that you have read and understand the procedures to follow in the event of an injury.

Contact

Thank you for your interest. For questions or comments, use the information below. We look forward to hearing from you soon.

Oregon Address
650 NE Holladay Street, Suite 1600
Portland, OR 97232

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Corporate Office
27442 Calle Arroyo
Cottage 45
San Juan Capistrano, CA 92675

Service Area
Nationwide Services, including Hawaii & Alaska

Phone
(714) 796-9110

Hours of Operation
Monday – Friday: 8:00 a.m. – 5:00 p.m.

Customer Contact Hours
For 24/7 After-Hours Support,
Call (949) 724-4504