Drug Test Authorization Form
Fastest Labs of El Cajon
Reason for Testing:
*
Pre-Employment
Random
Post Accident
For Cause
Court Order
Other
Drug Test to be Administered:
*
6 Panel Rapid UA
10 Panel Rapid UA
17 Panel Rapid UA
18 Panel Rapid UA
14 Panel Saliva
DOT Urine Test
USCG Urine Test
Alcohol Test:
DOT Breath Alcohol Test
Non-DOT Breath Alcohol Test
Saliva Alcohol Test
Urine Alcohol Test
Company Name:
*
DER Authorized By:
*
Employee Name:
Last 4 of Employee SSN or Drivers License Number:
*
Do You Want To Email a Copy of this Form to Your Employee?:
Yes
No
Employee's Email Address:
example@example.com
This Form Will Expire at 5:00 p.m. on:
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: