Drug & alcohol testing consent For admin useThis field is hidden when viewing the formAgency Name(Required)Candidate Name(Required) First Last Candidate Email(Required) Read and signI hereby agree to submit to a drug and/or alcohol test by furnishing a sample of my saliva via swab for analysis. I have been fully informed of the reason for this test and I understand what I am being tested for and the procedure involved. I am fully aware that the results of this test will become part of my employment record and may affect my placement. I understand that if at any time I refuse to submit to a drug or alcohol test, or if I otherwise fail to cooperate with testing procedures, my application for employment may be immediately withdrawn from consideration or I may be subject to immediate termination. Name First Last Signature(Required)DateDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920This field is hidden when viewing the formAgency RepresentativeThis field is hidden when viewing the formAgency Representative SignatureThis field is hidden when viewing the formDate