Notice of Request for Consumer Report

NOTICE OF REQUEST FOR CONSUMER REPORT/ PRE-EMPLOYMENT DRUG TESTING

In processing your application for employment, our Company may request a Consumer Report on you from a consumer-reporting agency. This may include information as to your character, general reputation, criminal record, personal characteristics, credit standing and mode of living. Any offer of employment is conditioned on a successful review of the Consumer Report.

Our Company is committed to maintaining a drug-free workplace. Therefore, all candidates for employments (applicants to whom a contingent offer of employment has been made) are required to complete a drug screening by a physician, lab, or facility of our Company’s choice. An offer of employment is contingent upon a candidate’s submission and successful completion of the test within 24 hours of the offer.

CONSUMER REPORT/ PRE-EMPLOYMENT DRUG TESTING ACKNOWLEDGEMENT

I, ______(please print), hereby acknowledge that I have read the foregoing disclosure statement concerning consumer reports and understand its contents. Furthermore, I have been informed by this Company, that it may request a consumer reporting agency to prepare a Consumer Report on me, which it will use for employment purposes. I authorize this Company, to request the preparation and use of the aforementioned Consumer Report. I understand that before I am denied employment, in whole or in part, because of any information contained in such a Consumer Report, that I will be provided with additional information in compliance with the Fair Credit Reporting Act, as amended in 1996 to include the Consumer Credit Reporting Reform Act (CCRRA).

I, ______(please print), hereby acknowledge that I have read the foregoing disclosure statement concerning pre-employment drug testing and agree to undergo this testing. I understand that the results of such a test will only be disclosed to this Company’s Human Resources personnel and other’s with a need to know, or as required by law. I understand that if I refuse to consent to testing, fail to provide a urine sample when requested, provide false or tampered urine sample, or fail to successfully complete the drug test, I will not be hired in accordance with this Company’s Policy.

I, ______(please print), understand that this employment release and any other company documents are not contracts of employment and that any individual who is hired may voluntarily leave or be terminated at any time, with or without cause.

______Signature of Applicant Date

Company ______