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I understand it is the policy of the company/organization to conduct
drug and/or alcohol tests of job applicants for the purpose of detecting drug
and/or alcohol abuse, and that one of the requirements for consideration of
employment with the company/organization is the satisfactory passing of the
company's/organization's drug and/or alcohol test(s).
For the purpose of being further considered for employment, I hereby agree to
submit to a drug and/or alcohol test.
I understand that favorable test results will not necessarily guarantee that I
will be employed by the company/organization.
If I am accepted for employment, I agree to take drug and/or alcohol tests
whenever requested by the company/organization, and I understand that the taking
of such tests is a condition of my continued employment.
I also give consent to the testing agency to release to the company/organization
and other officially interested parties the results of my tests.
At this time I consent to a drug and/or alcohol test.
_________________________________________________________________
(Signature of applicant)
(Date signed)
_________________________________________________________________
(Printed name of applicant)
(Signature of witness)
NOTE: This form should be customized with your company or
organization's name and should reference only drugs or alcohol, or both,
depending upon which options you select for testing requirements.
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