City Of Salem Pre-Employment Drug Testing Consent Form Page 2

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_______________________________
__________________________________
Print Applicant’s Name
Telephone Number
_________________________________________
_____________________________________________
Address
City, State, Zip
Applicant’s Signature:_______________________________________________________________________________
Date
Witness Signature: __________________________________________________________________________________
Date
_____________________________
_________________________________
Print Name of Parent or Guardian
Telephone Number
______________________________________
____________________________________________
Address
City, State, Zip
Parent or Guardian Signature:_______________________________________________________________________
Date
Witness Signature:__________________________________________________________________________________
Date

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