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This Pre-Employment Drug and/or Alcohol Testing Consent Form may be used by a company to have a drug and/or alcohol test administered to a job applicant. Employers may require applicants to submit to a drug and/or alcohol test as a condition for their application to be considered. By signing this form, the applicant voluntarily consents to undergo the testing process. This document informs the applicant of his or her rights and states that the results of the test will be held confidential. This should be used by employers located in Pennsylvania that require job candidates to submit to drug or alcohol testing.
Pre-Employment Drug and/or Alcohol Testing Consent This Pre-Employment Drug and/or Alcohol Testing Consent Form may be ocstoc Legal Agreements used by a Company to have a Drug and/or Alcohol test upon a new candidate before getting them employed. ALL INFORMATION AND FORMS ARE PROVIDED “AS IS” WITHOUT ANY EXPRESS OR IMPLIED WARRANTY, INCLUDING AS TO LEGAL EFFECT OR COMPLETENESS. They are for guidance and should be modified by you or your attorney to meet your specific needs and the laws of your state. Use at your own risk. Docstoc, its employees or contractors who wrote or modified any form, are NOT providing legal or any other kind of advice and are not creating or entering into an Attorney-Client relationship. The information and forms ® are not a substitute for the advice of your own attorney. Subject to our Terms of Service (http://www.docstoc.com/popterm.aspx?page_id=15). See back cover page and read more here (http://www.docstoc.com/popterm.aspx?page_id=114) for additional disclaimers and more. This document is not approved, endorsed by, or affiliated with any State, or governmental or licensing entity. Entire document © Docstoc, Inc., 2010, 2011 Attorney Drafted © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 1 PRE-EMPLOYMENT DRUG AND/OR ALCOHOL TESTING CONSENT FORM PRE-EMPLOYMENT DRUG AND/OR ALCOHOL TESTING POLICY As a condition for an employment application to be considered, applicants must understand and agree to submit to a drug and/or alcohol test. If the test results are positive, the applicant shall not be considered further by _____________________ [Instruction: Insert the name of company] (hereinafter referred to as the “Company”) for employment. The Company will pay the cost of the pre-employment drug/alcohol test. Any additional treatment or cost relating to the results of the testing is the applicant’s responsibility. The Company will maintain the results of the pre-employment drug/alcohol test. PRE-EMPLOYMENT AGREEMENT I, ___________________________________ [Instruction: Insert the name of the Applicant], understand the above conditions and hereby agree to comply with them (I understand what I am being tested for), the procedure involved, and do hereby freely and voluntarily give my consent to the testing laboratory designated by the Company to perform analytical tests deemed necessary to determine the absence or the presence of alcohol and/or drugs [Instruction: Check (X) for all that apply) in my ___ urine, ___ blood, _____ hair, or ___ breath as specified by statute and regulation of the Company. In addition, I understand that the results of this test will become part of my record. I understand that: 1. The authority may request proof that I am taking a controlled substance as directed pursuant to a lawful prescription issued in my name. If requested, I must provide such proof within 48 hours. 2. I have the right to request a re-test of the initial specimen at a licensed laboratory of my choice if I have a positive test for drugs. All requests for a re-test of the sample must be made within ten (10) working days of the receipt of the original positive test result. The results of the sample must be forwarded to me by the appointing authority of the agency. 3. Only duly-authorized Company officers, employees, and agents will have access to information furnished or obtained in connection with the test; they will maintain and protect the confidentiality of such information to the greatest extent possible; and they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from government entities. 4. The Company will require a drug screen and/or alcohol test under this policy randomly, and whenever I am involved in an on-the-job accident or injury under circumstances that suggest possible involvement or influence of drugs or alcohol in the accident or injury event, and I agree to submit to any such test. © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 2 This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered. I hereby authorize these test results to be released to ___________________________ [Instruction: Insert the name of the Company] __________________________________ ________________________ Applicant/Employee Signature Date __________________________________ _______________________ Supervisor’s Signature Date © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 3 Note: Carefully read and follow the Instructions and Comments contained in this document for your customization to suit your specific circumstances and requirements. You will want to delete the Instructions and Comments from open bracket (“[“) to close bracket (“]”) after reading and following them. You (or your attorney) may want to make additional modifications to meet your specific needs and the laws of your state ◊Where within this document you see this symbol: ◊ or an instruction states “Insert any number you choose◊,” or something similar, or there is a blank for the user to complete, please note that although Docstoc believes the information or number may be any that the user chooses, and that there is no law governing what the information or number should be, you might want to verify this, including by consulting with your own attorney practicing in your state, and be reasonable. INFORMATION AND FORMS ARE PROVIDED "AS IS" WITHOUT ANY EXPRESS OR IMPLIED WARRANTY OF ANY KIND INCLUDING WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT OF INTELLECTUAL PROPERTY, OR FITNESS FOR ANY PARTICULAR PURPOSE. IN NO EVENT SHALL DOCSTOC, INC., OR ITS AGENTS, OFFICERS, ATTORNEYS, ETC., BE LIABLE FOR ANY DAMAGES WHATSOEVER (INCLUDING, WITHOUT LIMITATION, DAMAGES FOR LOSS OF PROFITS, BUSINESS INTERRUPTION, LOSS OF INFORMATION) ARISING OUT OF THE USE OF OR INABILITY TO USE THE MATERIALS, EVEN IF DOCSTOC HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Your use of this document is deemed to be your agreement to the foregoing, the disclaimers on the cover page, and that you have read and agree to our Terms of Service (http://www.docstoc.com/popterm.aspx?page_id=15), as well as our disclaimer that Legal information is not legal advice, and the important content available here: Read More (http://www.docstoc.com/popterm.aspx?page_id=114) © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 4 document proprietary, copy not 4
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