(May be used with the Employment Application)
(By Applicant or Employee)

I, (name of applicant or employee), hereby voluntarily agree to submit to any lawful drug test requested and conducted by XYZ Employer which XYZ Employer deems, in its sole discretion, to be reasonably necessary to provide its workers with a safe working environment.

I, (name of applicant or employee), acknowledge that in the course of my employment, and as a prerequisite of employment with XYZ Employer, may be asked to submit to a random drug test and provide a urine, blood or breath sample as part of a substance abuse screening test.  I hereby consent to such tests and also agree to allow XYZ Employer the right to make lawful searches of my work area and my vehicle while on company property, and other lawful surveillance activities, in an effort to keep the workplace drug free.

I authorize that the results of any drug test be communicated and disclosed to third parties.  As a consequence of any positive result obtained by said test, I understand that I may not be offered a job with XYZ Employer or may be disciplined leading up to or including immediate discharge if currently employed by XYZ Employer.

I hereby indemnify, release and forever discharge and hold XYZ Employer and its subsidiaries and affiliated companies, agents and employees harmless from any and all claims, demands, judgments and legal fees arising out of or in connection with such tests, the results, or any lawful use of the results.