COVID Testing - Golden State Restaurant Group

COVID Testing

Please complete your
selection below.

Name*
First Last
Restaurant*
Optional COVID-19 Testing Decision*
- I choose to take a COVID-19 test
- I choose not to take a COVID-19 test
Date of Birth*
MM slash DD slash YYYY
Email*
Enter Email Confirm Email

Necessary to communicate with you testing times
Positive Test Disclosure*
If you test positive for COVID-19, you will be told not to return to work and to seek medical assistance as needed.
You will be given CDC recommendations on home quarantine/isolation and monitoring for symptoms, along with instructions on how to learn more about benefits (such as leave). For additional information on sick leave under your restaurant’s policies, please review your Employee Handbook and COVID related documents in your iSolved portal.
- I understand what happens if I test positive for COVID-19
Electronic Signature Consent*
By clicking ‘I agree’ below, you are agreeing that your click of ‘I agree’ is your electronic signature, and to use an electronic signature to demonstrate your acknowledgment. Your electronic signature is as legally binding as an ink signature. If you do not agree to electronic signatures and consent, please call (209) 938-1278 before continuing.
- I agree
Signature*