Fillable Pre-Employment Drug Testing Consent And Release Form printable pdf download

Pre-Employment Drug Testing Consent And Release Form

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Pre-Employment Drug Testing Consent and Release Form

I hereby consent to submit to urinalysis and/or other tests as shall be determined by

________________________ (company name) in the selection process of applicants for

employment, for the purpose of determining the drug content thereof.

I agree that:

__________________________________________________ (name of physician or clinic) may collect these

specimens for these tests and may test them or forward them to a testing laboratory

designated by the company for analysis.

I further agree to and hereby authorize the release of the results of said tests to the

company.

I understand that it is the current illegal use of drugs and/or abuse of alcohol that prohibits

me from being employed at this Company.

I further agree to hold harmless the Company and its agents (including the above named

physician or clinic) from any liability arising in whole or part out of the collection of

specimens, testing, and use of the information from said testing in connection with the

Company’s consideration of my employment application.

I further agree that a reproduced copy of this pre-employment consent and release form

shall have the same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that

my signing of this consent and release form is a voluntary act on my part and that I have

not been coerced into signing this document by anyone.

Applicant Printed Name: ______________________

SS#: __________________________________

Applicant Signature: _________________________________________

Date:__________________

Witness Printed Name: _______________________________

Witness Signature: ____________________________

Pre-Employment Drug Testing Consent And Release Form

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