ALCOHOL/DRUG SCREENING THROUGH URINALYSIS APPLICANT CONSENT FORM

I, (NAME) understand that as a part of the pre-employment process as required by Town of Burgaw for the position of (POSITION) I must submit to a urinalysis drug screening.

I hereby voluntarily consent to and authorize this test for the purpose of screening for the presence of illegal and unauthorized drugs. I

I hereby authorize the release of the results of this test to the Town of Burgaw's Medical Review Officer and Town of Burgaw officials with a need to know.

I acknowledge that I have been notified of the Town of Burgaw's drug testing policy.

I will notify the Medical Review Officer concerning all current and recent use by me of prescription and over-the-counter medications at the time of the urine test.

I understand:

1. That a negative result is a condition of employment. 

2. That all-initial positive results will be confirmed by an approved laboratory using a Gas Chromatography/Mass Spectrometry test. 

3. That if I am rejected for employment on the basis of a confirmed positive drug test result, I cannot be considered for employment with the Town of Burgaw for one year.

4. That refusal to take the test will result in my no longer being considered as a candidate for employment for the position sought.

5. That I may request a retest, at my own expense, of the same sample in the event of a positive test result.

6. That I may discuss positive test results with the Medical Review Officer, to determine if there are alternative explanations for the positive test results. 

7.That the results of the urinalysis will be available to me as soon as possible after receipt by the Town of Burgaw's Medical Review Officer.