VOLUNTARY CONSENT AND RELEASE OF LIABILITY FOR DRUG/ALCOHOL TESTING
I understand that, for my protection and for the protection of others with whom I will be working, it is the Company’s policy to prohibit the use, possession, or sale of illegal or unauthorized drugs and alcoholic beverages on Company property or during working hours. Illegal and/or unauthorized drugs include the following: marijuana; narcotics; all other drugs not prescribed by a licensed physician for use by the person possessing them; and excessive quantities of prescribed drugs which may adversely influence performance or behavior.
My signature below constitutes voluntary consent to the Company’s request for me to provide urine and/or blood samples for alcohol and drug analysis. I fully understand that failure to cooperate with any request for a blood or urine sample for chemical analysis may result in discipline up to and including immediate discharge. I further agree to release and hold harmless the Company and its employees and agents from any and all liability whatsoever on account of, or arising from, this request to furnish a blood and/or urine sample, the testing of such sample, or disclosure of the results of any such chemical analysis.
You are not required to disclose information about physical limitations that you believe will not interfere with your capability to do
the job. On the other hand, if you want the employer to consider special arrangements to accommodate a physical or mental
impairment, you may identify that impairment in the space provided and suggest the kind of accommodation that you believe
would be appropriate.
Please Read Carefully
1. Equal Employment Opportunity. Vox/Reid Printing is an equal opportunity employer. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age or physical or mental disability. This policy of non-discrimination extends to all terms, conditions and privileges of employment and to all personnel actions.
2. Authorization by Application. I authorized Vox/Reid to contact my former employers and references listed on this application, and I authorized such individuals and organizations to release information required by Vox/Reid Printing. The information I have supplied on this application and by way of any oral statements is true and accurate, and I understand that any intentional misstatement by me may result in immediate dismissal.
3. Employment at Will. In consideration of my employment, I agree to conform to the rules and regulations of Vox/Reid Printing as set forth in its employee handbook, and understand that my employment and compensation may be terminated with or without notice, at any time, at the option of either the Company or myself. I understand that no other company official has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing except by a written document dated and signed by myself and an officer of the Company. I also understand that the company’s policies contained in the employee handbook do not constitute a contract of employment and may be modified by management at any time.
I understand that this application will remain effective for a period of thirty (30) days from the date submitted, and, thereafter, that I must re-apply if I wish to continue to be considered for employment.
Please include your name again that you are the applicant and certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.