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Drug Test Consent Form
Consent for Pre-Employment, Random or Reasonable Suspicion Drug Test and Release
Covenant not to Sue and Indemnity Agreement
I herby consent to allow Comprehensive Medical Staffing or its affiliate companies to
take a specimen of my hair, urine, or blood and submit it for a pre-employment,
random, or reasonable suspicion drug test. I further consent to allow the laboratory
testing service to make the results of such screen available to prospective or current
employer, Comprehensive Medical Staffing, and its affiliate companies.
In consideration for such services being rendered on my behalf, I herby release the
laboratory testing service, its officers, agents and employees from any and all claims,
which I might otherwise have due to such results being made available. I herby
consent not to file any action at law or in equity against Comprehensive Medical
Staffing and its affiliate companies, the laboratory testing service, the respective
officers, agents or employees in connection with the results of such screen being made
so available and I hereby agree to Indemnify and Hold Harmless Comprehensive
Medical Staffing, and its affiliate companies, and the laboratory testing service, the
respective officers, agents or employees from all damages, expenses, reasonable
attorney’s fees, and costs of court which they or any of them may suffer or incur, jointly
or severally, due to the results of such screen being made so available.
I am also aware that a positive result on any one of the test panels will result in
disqualification from obtaining a position with Comprehensive Medical Staffing and its
affiliate companies.
Signed this __________day of ___________, 200____.
Current Medications
Prescription & Non Prescription:
_________________________________
________________________________
(Signature) (Print Name)
Applicant Social Security Number
___ ___ ___-___ ___-___ ___ ___ ___
Revised 04.29.03 F:\INTAKE\Drug Test Consent Form.doc