Employment Application – Drug Test

    Agreement and Consent to Drug and/or Alcohol Testing


    I, __________________________________________, hereby give my consent to undergo a pre-employment drug and/or alcohol test requested by Barron Service Parts Co. (“BSP”) and to furnish a sample of my urine, breath, and/or blood for analysis. I understand that my current illegal use of drugs and/or abuse of alcohol will prohibit me from obtaining employment with BSP. I authorize and give full permission to have BSP and/or its authorized agents and physicians to send any specimen(s) so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to BSP.


    I also agree, upon any post-employment request made under the drug/alcohol testing policy of BSP, a copy of which has been furnished to me, to submit to a drug and/or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under BSP’s policy, or if I otherwise fail to cooperate with the testing procedures, I will be subject to penalties up to and including immediate termination. I authorize and give full permission to have BSP and/or its authorized agents and physicians to send the specimen(s) so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to BSP.


    I will hold harmless BSP, its agents and physicians, and any testing laboratory BSP might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including denial of employment or loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test. I will further hold harmless BSP, its agents and physicians, and any testing laboratory BSP might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy.


    This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered.


    I ALSO UNDERSTAND THAT BSP WILL REQUIRE A POST-EMPLOYMENT DRUG SCREEN TEST WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT.











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