AUTHORIZATION AND CONSENT FOR DRUG SCREENING
I consent to a pre-employment test to detect the use of illegal or controlled substances, alcohol, or prescription medication without a prescription. I consent to provide a specimen of my urine and/or blood or hair as may be requested in conformity with Selective Staffing policies and procedures. I certify that urine submitted for such a drug screen will be my own. I understand that I have a right to receive a copy of this authorization.
I understand that Selective Staffing may require a post-accident screening to test for illegal drugs or controlled substances, alcohol, or prescription medication without a prescription when a work-related accident is reported, in accordance with Selective Staffing’s policy, and I consent to such a drug screening.
I consent to the release of drug screen results to Selective Staffing also authorize any physician, hospital or clinic who may have examined me previously for drug or substance abuse to release to Selective Staffing a complete record of the findings, results or opinions.
I understand and agree that the results of my drug screens may be used in determining my employment eligibility. If I refuse to sign this consent, fail to take a pre-employment or accident-related drug screen, or fail any portion of the test, I will not be considered for employment, or if employed, I will be terminated.
I understand and agree that Selective Staffing may release the results of my pre-employment and/or post-accident drug screens to the State Unemployment Department if a claim for unemployment insurance is filed by me or on my behalf.
I agree to hold all parties harmless and not to sue in connection with any aspect of drug screen testing or its effect on my employment status. I understand that if I have any questions about the meaning of the provisions in this authorization and consent or the drug screens, they will be answered on request.