I hereby consent to submit to urinalysis and/or other tests as shall be determined by Myrick Marine Contracting Corp. in the selection process of applicants for employment, for the purpose of determining the drug content thereof.
I agree that:
may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by Myrick Marine Contracting Corp. for analysis.
I further agree to and hereby authorize the release of the results of said tests to Myrick Marine Contracting Corp.
I understand that it is the current use of illegal drugs that prohibits me from being employed at Myrick Marine Contracting Corp.
I further agree to hold harmless Myrick Marine Contracting Corp. and it's agents (including arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with Myrick Marine Contracting Corp. consideration of my application of employment.
I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.
I have carefully read the foregoing and fully understand its consents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.
I understand that my saliva, urine, and/or blood will be tested for illegal drugs and/or alcohol.
I understand if I decline to sign this consent and thereby decline to take the test, the medical examination will not be completed. The management of Myrick Marine Contracting Corp., will be so notified and my application for employment will be rejected.
I understand that if the test is confirmed as positive, the results will be reported to the management of Myrick Marine Contracting Corp., and my application for employment will be rejected.
The following are: (a) the prescription RX and non-prescription drugs that I presently take routinely: or (b) drugs I have taken in the last 30 days (Do not include any birth control prescription); or (c) if not applicable, check box NA.
I understand that if I do not reveal the presence of prescription drugs, my employment may be terminated. I understand that there may be some jobs for which the use of prescription drugs may be unacceptable.
To the best of your knowledge do you have or have had any of the following medical problems? This will help in placing you in a job that you are physically capable of performing.
(for "yes" responses, indicate nature of injury or illness, date of injury or illness and name of physician in "remarks".