Consent for Drug/Alcohol Testing

CONSENT FOR DRUG/ALCOHOL TESTING

If you are offered and accept employment with __________________________________ (Company), in the interest of safety for all concerned, you will be required to take a urine test for drug and/or alcohol use.

I, ___________________________________, have been fully informed of the reason for this urine test for drug and/or alcohol (I understand what I am being tested for), the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record.

If this test is positive, and for this reason I am not hired, I understand that I will be given the opportunity to explain the results of this test.

I hereby authorize these test results to be released to ____________________________________________________________________ (Company Name).

APPLICANT:

_______________________________________
Signature

_______________________________________
Printed Name

______________
Date

WITNESS:


_______________________________________
Signature

_______________________________________
Printed Name

______________
Date