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CONSENT FOR DRUG AND ALCOHOL TESTING

Current Date

Instructions: As a condition of employment with Company Name or for an application for employment to be considered, you will be required to submit to testing for drug and/or alcohol use. If the test results are positive, you cannot be employed by Company Name for any reason. You must be at least 18 years of age to agree to this consent form.

If you are not at least 18 years of age, you must additionally get a parent or guardian to sign this form in the space provided below. I understand the reason for this drug and alcohol test and do hereby freely give my consent to have this test taken as a condition of my employment with Company Name. I also understand that the results of this test shall be made available to Company Name and become part of my permanent record with Company Name. I further understand that if my test results come back as positive for either drugs or alcohol, I shall not be considered for employment by Company Name.

I hereby authorize any Company-approved medical professional or laboratory to conduct such testing and to provide the results to Company Name. I understand that by signing this consent form, I hereby release Company Name and any person affiliated with Company Name from any liability arising out of either the testing procedure, the results of such testing, or any other liability or damages, whether direct or indirect, from undergoing this Drug and Alcohol Testing. I hereby authorize these test results to be released to Company Name.

Print Name:

Date when the contact was signed

Parent or Guardian Signature:

Human Resources Department