Consent to Drug Testing

Consent to Drug Testing

I, {Employee/Interviewee Name}, do hereby agree to provide my {urine, blood, etc.} for the purposes of drug testing {prior to/during} employment with {Name of Company}.

I understand that refusing to submit to this test will result in {termination, loss of consideration for new job}.

I further understand that any positive result that comes from this test will result in {termination, drug counseling, etc.}.

I will hold harmless {Name of Company}, any physicians or medical staff involved, and the drug testing facility as a whole, for any damage that may arise as a result of this testing.

I authorize {Name of Company} to provide my pertinent personal and medical information to the drug testing facility, and give {Name of Company} permission to submit my specimen(s) to the drug testing facility.

I agree to this policy freely and willingly on this {date} day of {month}, {year}.

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Employee Name                                                 Employee Signature

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Company Representative Name                      Company Representative Signature