Preview Medical Staff Drug Test Consent Form

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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

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