Drug and Alcohol Testing Consent Form 

  • I hereby agree, upon a request made under the drug/alcohol testing policy of Community Action Network to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis. 

  • I understand and agree that if I, at any time, refuse to submit to a drug or alcohol test under company policy, of if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination.

  • I further authorize and give full permission for Community Action Network to release any and all documentation relating to such test to Community Action Network and/or to any governmental entity involved in a legal proceeding or investigation connected with the test.

  • Finally, I authorize Community Action Network to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test.




You will be asked to submit an E-Signature with your name and email on the following page. 

By signing this form, you agree to all of the listed items.
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