Title Page
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CONSENT PRIOR TO DRUG TEST
CONSENT PRIOR TO DRUG TEST
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I hereby give my voluntary consent for a urine and / or blood sample to be collected from me and submitted for a drug and / or alcohol screening test. Further, I hereby consent to the release of the test results to LEE LEWIS CONSTRUCTION, INC. I understand that a positive result may result in the termination of my employment or NOT being hired if this is a pre-employment test. I further consent that such test results shall be admissible by evidence at any proceedings in which disciplinary action taken against me for using, selling, buying, transferring, receiving, possessing, or being under the influence of alcohol, drugs, or controlled substances is placed in issue. I further consent that such test results may be released to any insurer of LEE LEWIS CONSTRUCTIONS, INC., and shall be admissible in any proceedings in which eligibility for benefits is placed in issue.
I further agree to hold LEE LEWIS CONSTRUCTION, INC. harmless for any negligent testing, reporting, collection, or publishing done by any independent laboratory.
I UNDERSTAND THAT I WILL NOT BE HIRED IF I FAIL THIS DRUG TEST BECAUSE OF OR RESULTING FROM THE USE OF NARCOTICS. I UNDERSTAND THAT IF I AM CURRENTLY EMPLOYED BY LEE LEWIS CONSTRUCTION, INC., AND FAIL THIS DRUG TEST BECAUSE OF OR RESULTING FROM THE USE OF NARCOTICS, I WILL BE TERMINATED AND I WILL NOT BE ELIGIBLE FOR REHIRE.
I also understand that if I REFUSE to sign this consent or submit to the urinalysis and / or blood screening, I will be terminated or NOT hired if this is a pre-employment test. -
Date / Time
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Last 4 of Employee's SSN
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Name
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Applicant / Employee Signature
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Date Passed
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Date Failed
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Lee Lewis Construction, Inc. Represenative
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Photo
