If you are offered and accept employment with___________________ (company), in the interest of safety for all concerned, you will be required to take a urine test for drug and/or alcohol use.
I,________, have been fully informed of the reason for this urine test for drug and/or alcohol (I understand what I am being tested for), the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record.
Waiver. No consent or waiver, expressed or implied, by any party to or of any breach or default by the other party in the performance of obligations hereunder will be deemed or construed to be a consent or waiver to or of any other breach or default in the performance by such other party of the same or any other obligation under this Agreement. Failure on the part of a party to complain of any act or failure to act of the other party or to declare the other party in default, irrespective of how long such failure continues, will not constitute a waiver by such party of its rights under this Agreement.
If this test is positive, and for this reason I am not hired, I understand that I will be given the opportunity to explain the results of this test.
I hereby authorize these test results to be released to_________________ (company name).