Arizona Polygraph Consent


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                             This Polygraph Consent form can be used by a company or employer when administering a
                             polygraph examination to an employee. Polygraphs are used to determine the accuracy
                             and reliability of the answers given by employees. This document gives legal consent by
                             the employee to undergo the polygraph examination. By signing this document, the
                             employee voluntarily agrees to participate in the examination. This form should be used by
                             an employer located in Arizona whenever administering a polygraph examination to an

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                                    POLYGRAPH CONSENT

Name: ________________________ [Instruction: Insert the name of Employee]

Date of Polygraph Examination: ____ [Month] ____ [Date], 20____ [Year]

I voluntarily agree to a polygraph examination on the above date.

A company representative has advised me of the following:

1. I am guaranteed by the law under § 29.22.2002 of United States Code, the right not to take
   this examination as a condition of employment or continued employment.

2. I have not been coerced or forced in any way into either taking this test or signing this
   consent agreement. This act is entirely voluntary on my part.

3. I further consent and agree to the placing of the required apparatus, cuffs, and devices on the
   appropriate places on myself.

4. I understand the conditions associated with a Polygraph Examination and the Company has
   thoroughly explained the nature of examination.

5. I have retained a copy of this agreement for my records.


   [Instruction: Insert signature of Employee]


   [Instruction: Insert the name of Employee]

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