Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S
""E#A" A$% S!&C!"' P&()*!E% !( %S!&*U!E+ PU*"S)+ (,,E& ,(& SA"E+ "CE$SE (& SU*"CE$SE+ #-E (& %SC"(SE !( A$' (!)E&
PA&!'+ !)S P&(%UC! $ )A&% C(P' (& %#!A" ,(&.. A"" (,,E$%E&S /"" *E SUE% $ A C(U&! (, "A/.
DRUG TESTING CONSENT AGREEMENT
!his %r0g !esting Consent Agree1ent 23Agree1ent34 is 1ade and effective this 5%A!E6+
*E!/EE$7 5E.P"('EE $A.E6 2the 3E1ployee34+ an individ0al with his 1ain address at7
AND: [COMPANY NAME] 2the 3Co1pany34+ a corporation organi8ed and e9isting
0nder the laws of the 5S!A!E:P&(-$CE6+ with its head office located at7
n connection with 1y application for e1ploy1ent with the Co1pany+ hereby agree as follows7
1. TERMS
have applied for e1ploy1ent with 5C(.PA$'6 in a position that re;0ires 1e to
operate an a0to1obile or tr0c<. As a condition for 1y application being considered+
0nderstand and agree to 0ndergo s0bstance screening. 0nderstand that if 1y test
res0lts are positive+ shall not be considered f0rther by 5C(.PA$'6 for a car or tr0c<
driver position.
hereby a0thori8e any physician+ laboratory+ hospital or 1edical professional retained
by the Co1pany for screening p0rposes to cond0ct s0ch screening and to provide the
res0lts to the Co1pany and release the Co1pany and any person affiliated with
5C(.PA$'6 and any s0ch instit0tion or person cond0cting the screening+ fro1 liability
therefore.
!his Agree1ent represents the entire 0nderstanding and agree1ent relating to its s0b=ect 1atter.
Co1pany shall be entitled f0lly to rely on this Agree1ent. 0nderstand that have no g0arantee of
e1ploy1ent and that the Co1pany 1ay deter1ine not to hire 1e for any lawf0l reason.
E.P"('EE C(.PA$'

%r0g !esting Consent Agree1ent
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Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S
""E#A" A$% S!&C!"' P&()*!E% !( %S!&*U!E+ PU*"S)+ (,,E& ,(& SA"E+ "CE$SE (& SU*"CE$SE+ #-E (& %SC"(SE !( A$' (!)E&
PA&!'+ !)S P&(%UC! $ )A&% C(P' (& %#!A" ,(&.. A"" (,,E$%E&S /"" *E SUE% $ A C(U&! (, "A/.
A0thori8ed Signat0re A0thori8ed Signat0re

Print $a1e and !itle Print $a1e and !itle
%r0g !esting Consent Agree1ent
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