Pre-Employment Screening

CONSENT FORM
PRE-EMPLOYMENT ALCOHOL, DRUG AND SUBSTANCE SCREENING

I hereby consent for SMP Industries, Incorporated to collect blood, urine or saliva samples from me and to conduct other necessary medical tests to determine the presence or use of alcohol, drugs, or controlled substances. Further, I give my consent for the release of test results, and other relevant medical information to authorized company management for appropriate review. I also understand that, if I refuse to consent, I may be denied employment.


Agreed:


First Name: Last Name:

Signature: Please sign Here:

Date:


Witness:

Date:


REFUSED:


Signature: Date:



Witness: Date:


Reason for positive finding, if any:

Reason for refusing to consent:


Marie Vickery, SMP Industries, Inc.
Human Resources 423.892.3720 x301
marie.vickery@smpindustries.com

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