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:

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Signature

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Printed Name

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Date


WITNESS:


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Signature

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Printed Name

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Date