If you have lived at the above residence for less than 3 years.

I consent to participation in this company's "Drug and Alcohol Testing Program". It is my right to expect that DHHS protocols regarding obtaining specimens for drug and alcohol testing are utilized and that all urine drug and alcohol tests are submitted to a confirmatory test if the initial test is positive. I reserve the right to bring to the attention of management any discrepancies in testing protocol, such that management review can be utilized. A. I understand that a pre-employment urine drug screen for controlled substances is a prerequisite for employment, and failure to pass this screen, and/or a refusal to submit to testing will result in my application for employment receiving no further consideration. If my test is positive, I have the right to request that the split specimen be re-tested at a different DHHS certified laboratory, but agree to assume responsibility for the cost of this test. If I am unable to pay this fee, I agree to work out a billing arrangement with my potential employer if I desire to pursue the testing of the split specimen. I understand that if the split specimen test result is negative, I will be reimbursed the cost of this test by the potential employer. B. I understand that I may be asked to submit to a urine drug and or alcohol test if, in the opinion of a trained supervisor, there is ample evidence to suspect drug and/or alcohol impairment while at work. C. I understand that if I sustain an injury at work or am involved in an accident while on company time, premises and/or utilizing company equipment and/or vehicles, I will be asked to submit to a post accident drug and/or alcohol test. D. I understand that my potential employer has a “zero tolerance” policy, and a positive urine drug and/or alcohol test would result in termination or retraction of a job offer. E. I understand that a refusal to test in any circumstance is treated as a positive test. It is my right to ask, in writing, for the results of any drug and/or alcohol testing performed on me during the course of my employment with this company. I also have the right to request testing of the split specimen within 72 hours of MRO notification of a positive test result. I authorize the collection site to release alcohol and/or drug test results, and any other pertinent information concerning the collection of my alcohol and/or urine samples to the Medical Review Officer designated by my company. I consent to have the laboratory release the results of my alcohol and/or drug testing to the Medical Review Officer designated by my company, and authorize the Medical Review Officer, to release these results to my employer after verification. I understand the results of ANY alcohol or drug testing will NOT be otherwise released without my express written consent for such.