US-00957BG free printable template

Consent Form to Pre-Employment Drug Screening To Company Name of Applicant Social Security Number Telephone Number Alternate Phone Number if available Applicant Please read entire document prior to signing. Type of Test Job Applicant/Pre-Employment drugs only Request I have been requested to provide a urine specimen for analysis for controlled substances. I understand that this analysis may indicate the presence of controlled substances in my system* Collection Site I have been instructed to go...to a collection site within number of days business days after accepting an offer of employment. If I am unable to go to a testing site within number of days business days following the acceptance of my offer I will need to obtain approval from the individual who sent the offer of employment letter to me. Extending the time frame for testing will not be guaranteed* I understand that accommodate me. Laboratory Name of laboratory is the organization that will be testing the sample. Refusal I...understand that I have the right to refuse to undergo testing for controlled substances. If I refuse I understand that my conditional offer of employment will be withdrawn if I am a job applicant. Consent I consent to the urine sample collection as specified above. I also consent to testing for controlled substance by the laboratory referred to above and the release of the laboratory test results to a medical review officer and then to Consequences I understand that a positive test result for...controlled substances will result in the withdrawal of any job offer that has been made to me if I am an applicant. I UNDERSTAND THE ABOVE CONDITIONS AND I AGREE TO COMPLY WITH THEM. Witness my signature this the day of 20. Type of Test Job Applicant/Pre-Employment drugs only Request I have been requested to provide a urine specimen for analysis for controlled substances. I understand that this analysis may indicate the presence of controlled substances in my system* Collection Site I have been...instructed to go to a collection site within number of days business days after accepting an offer of employment. I understand that this analysis may indicate the presence of controlled substances in my system* Collection Site I have been instructed to go to a collection site within number of days business days after accepting an offer of employment. If I am unable to go to a testing site within number of days business days following the acceptance of my offer I will need to obtain approval from...the individual who sent the offer of employment letter to me. If I am unable to go to a testing site within number of days business days following the acceptance of my offer I will need to obtain approval from the individual who sent the offer of employment letter to me. Extending the time frame for testing will not be guaranteed* I understand that accommodate me. Laboratory Name of laboratory is the organization that will be testing the sample. Extending the time frame for testing will not be...guaranteed* I understand that accommodate me. Laboratory Name of laboratory is the organization that will be testing the sample. Refusal I understand that I have the right to refuse to undergo testing for controlled substances. If I refuse I understand that my conditional offer of employment will be withdrawn if I am a job applicant.