Date:
I, __________________, understand that ___________________ (“Company”) requires all applicants for employment to take a urine test for drug and/or alcohol use.
I hereby freely and voluntarily give my consent to such test, to be administered on, _______________, having been fully informed of the test procedure involved, of what I am being tested for, and that a copy of the results will be forwarded to and placed in my record if I am ultimately hired. If not hired, I understand that the Company shall destroy all such records.
I also understand that, in the event of a positive test result, the Company will give me an opportunity to explain such a result….
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