Date:
I, _________________, hereby voluntarily give consent to a polygraph (lie detector) test to be administered on ________________, at ________________________________, the results of which will be forwarded to: _________________________________ for analysis.
I declare that I have not been coerced in any manner whatsoever to submit to this test or to sign this consent form and I understand that I have a legal right to refuse to submit to this test as a condition of new or continued employment….
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