Drug Testing Testing Testing Testing Consent Consent Consent Consent And Release Release Release Release Of Liability Liability Liability Liability Form printable pdf download

Drug

Testing

Consent

and

Release

Release of of of of Liability

Liability

Form

Drug

Drug Testing

Testing

Testing Consent

Consent

Consent and

and

and Release

Release

Liability

Liability Form

Form

I understand that as a condition of employment with COCHHBHA Enterprises, Inc. d/b/a CEI Staffing, I may be

required to submit a sample of my urine and/or blood for chemical analysis. I understand that a certified

laboratory will conduct the analysis. The purpose of this analysis is to check for the presence of illegal or non-

prescription drugs are alcohol in my system. I understand that a drug test will be required for the selection

process of applicants for employment. I also understand that a drug test may be required for the following

reasonable

suspicion,

post

accident,

post

rehabilitation,

and

for

routine

fitness

for

duty

reasons: reasonable

reasonable suspicion,

suspicion, post

post accident,

accident, post

post rehabilitation,

rehabilitation, and

and for

for routine

routine fitness

fitness for

for duty

duty.

I hereby give permission for any certified laboratory to release the results of this test to the company. I

consent freely and voluntarily to this request for urine and/or blood samples, specimen. I hereby release the

company from any liability arising from this request to furnish urine and/or blood samples, the testing of the

urine and/or blood and any decision made concerning my application for employment which may be based in

whole or in part upon the result of the test analysis.

I understand that the presence of any illegal or non-prescription drug or alcohol in my system may result in the

denial of employment with the company or the termination of that employment. I further understand that

employment with the company may be conditioned upon my willingness to submit to and the results of drug

and/or alcohol testing required by the company. Likewise, I understand that refusal to submit to or cooperate

with any such testing may result in termination of my employment.

Applicant Name: ________________________________

S.S. #: __________________

Applicant Signature: ______________________________

Date: __________________

The

The signed

signed

signed original

original

original copy

copy

copy of of of of this

this

this agreement

agreement

agreement should

should

should be

be faxed

faxed

faxed to to to to your

your

your manager

manager

manager so so so so that

that

that it it it it will

will

will be

be filed

filed

filed in in in in

your

personal

file.

Please

keep

this

copy

for

your

records.

your

your personal

personal file.

file. Please

Please keep

keep this

this copy

copy for

for your

your records.

records.

Drug Testing Testing Testing Testing Consent Consent Consent Consent And Release Release Release Release Of Liability Liability Liability Liability Form

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