Consent Form - Drug And Alcohol Testing
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1
2CONSENT FORM – DRUG AND ALCOHOL TESTING
I, ______________________________________, consent to allow Dodge Ridge to
collect urine and blood specimens from me for testing for alcohol, drugs, and controlled
substances. I also give my consent for the release of the test results to appropriate
management employees. I understand that if I decline to sign this consent and decline to take
the test, my application for employment may be rejected or my employment with the company
may be terminated.
Agreed to: ______________________________________ Date: _________________________
Signature of Employee
Refused: ________________________________________ Date: _________________________
Signature of Employee
Reason for Refusal: _____________________________________________________________.
NOTE: If under 18, please also complete the APPLICANTS UNDER AGE 18 Drug and Alcohol
Screening Consent Form Addition
Revised: 8/25/11
9/1/2011
Drug_and_Alcohol_Screening_Consent_Form
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