APPLICANT: READ BOTH SECTIONS AND SIGN ABOVE:
The information provided by me in this application for employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statement will be considered as cause for possible dismissal.
NOTIFICATION AND AUTHORIZATION OF DRUG TESTING
I understand that according to the Heartland Fabrication Policy, I am required to submit a chemical analysis of my urine. I understand that this analysis will be conducted onsite and all non-negative results will be sent for MRO review. Screenings will be performed for any of the following reasons: pre-employment, random, post-accident, reasonable suspicion and upon return from an extended leave of absence. I consent freely and voluntarily to this request for urine specimen. I hereby and herewith release Heartland Fabrication, the MRO, their employees, agents and contractors from any liability whatsoever arising from this request to furnish a urine sample, the testing of the sample and decisions made concerning my employment based upon the results of the sample analysis. I consent to the MRO releasing the results of the tests to Heartland Fabrication. I understand that if I decline to sign this Consent and thereby decline to have the urine test, my employment with Heartland Fabrication may be jeopardized. I understand a documented chain of specimen custody exists to ensure the identity and integrity of my urine sample throughout the collection and testing process. I understand that failing a specimen test would result in termination.
NOTIFICATION AND AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATION
I hereby authorize Heartland Fabrication or its agents to investigate my background to determine any and all information of concern to my record, whether same is of record or not, and I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information. Additionally, you are hereby authorized to make any investigation of my personal history, educational background, military record and criminal records through an investigative or credit agency or bureau of your choice. I authorize the release of this information by the appropriate agencies to the investigating service.
This authorization, in original or copy form, shall be valid for this and for any future reports and updated that may be requested.