Consent Form - Drug And Alcohol Testing (Page 2 of 2) in pdf

Consent Form - Drug And Alcohol Testing Page 2

APPLICANTS UNDER AGE 18

Drug and Alcohol Screening Consent Form Addition

In addition to providing your signed Drug and Alcohol Screening Consent Form

Please have your parent or legal guardian complete this form

I understand the above conditions and Dodge Ridge’s drug and alcohol testing policy

and authorize Dodge Ridge to administer testing for alcohol, drugs, and controlled substances

on my minor child or dependent, including by collecting urine and blood specimens. I consent

to such required testing and to the disclosure of the release of the test results to appropriate

management employees. By signing below, I hereby represent that I am the parent or legal

guardian of the minor identified below and am providing my consent for the testing for alcohol,

drugs, and controlled substances of the minor.

NAME OF MINOR APPLYING FOR EMPLOYMENT: _____________________________________

NAME OF PARENT OR LEGAL GUARDIAN: ___________________________________________

RELATIONSHIP TO APPLICANT/EMPLOYEE: __________________________________________

SIGNATURE OF PARENT OR LEGAL GUARDIAN: _______________________________________

DATE: _________________________________

Revised: 8/25/11

9/1/2011

Drug_and_Alcohol_Screening_Consent_Form

Consent Form - Drug And Alcohol Testing Page 2