Background Check & Drug Test Consent
BACKGROUND CHECK PERMISSION
In connection with my application to teach music lessons on behalf of Company, I hereby agree as follows:
As a condition of Company’s consideration of my application, I give permission to Company to investigate my personal and employment history. I understand that this background investigation may include, but not be limited to, verification of all information on my employment application.
I have applied for employment with Vet-1-1. In order for my application being considered, I understand and agree to undergo substance testing upon employment offer. I understand that if my test results are positive, I shall notbe considered for employment with Vet-1-1. I understand that if I receive a dilute drug test result, I will be required to take a second drug test within 24 hours of receipt of the dilute result. A hair follicle test will not be offered. If Irefuse the blood test or do not stay within the required timeline for having the tests administered, I shall not be considered for employment with Vet-1-1.
I hereby authorize any physician, laboratory, hospital or medical professional retained by Vet-1-1 for testing purposes to conduct such testing and to provide the results to Vet-1-1 and I release Vet-1-1 and any person affiliated with Vet-1-1 and any such institution or person conducting the testing, fromliability.
Testing may include but is not limited to the following substances:
Marijuana – THC Cocaine – COC Amphetamine – AMP Methamphetamine – mAMP Phencyclidine – PCP Benzodiazepines – BZO Methadone – MTD Opiate – OPI
Adulteration tests: Oxidants Specific gravity pH Nitrite Glutaraldehyde Creatinine
I will hold harmless Vet-1-1, its company physician, and any testing laboratory Vet-1-1 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; this may include loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if Vet-1-1 or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless Vet-1-1, its company physician, and any testing laboratory Vet-1-1 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 and the procedures. 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 specifically give permission to Company to contact all of my prior employers for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history with Company, consent to the release of such information orally or in writing, and hereby release them from all liability and agree not to sue them for defamation or other claims based upon any statements they make to any representative of Company. I further waive all rights I may have under law to receive a copy of any written statement provided by any of my former employers to Company. I further agree to indemnify all past employers for any liability they may incur because of their reliance upon this Agreement.
I further give permission to the Company to receive a copy of any information obtained in the file of any federal, state, or local court, or governmental agency concerning or relating to me. I further consent to the release of such information and waive any right under law concerning notification of the request for a release of such information. In the event a law does not provide for prospective employers to have access to information, I hereby delegate Company as my agent for the receipt of information. I understand that the scope of this investigation will be limited as required by applicable law.
I agree to fully cooperate in Company’s background investigation, and to sign any waivers or releases that may be required as part of this investigation.
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Signed by Christopher Lavallee
Signed On: August 21, 2019
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Document Name: Background Check & Drug Test Consent
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