Polygraph Consent
ocstoc Legal Agreements
This Polygraph Consent form can be used by Companies to determine the
accuracy and reliability of the answers given by their employees. This
Polygraph Test form gives legal consent by Employees to undergo the
Polygraph Test.
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Attorney Drafted
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
appropriate place 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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