Chawanakee USD | E 4112.41, 4212.41,4312.41 Personnel
Pre-Employment Drug/Alcohol Testing
Consent For Drug/Alcohol Test
Social Security Number:
Applicant for the position of
I hereby consent and agree to give a specimen of my (urine or blood)_ to the examining physician, to be used to detect the presence of drugs, alcohol or medications in my body. I further consent and agree that upon request by (district) , the laboratory results of any tests performed on this specimen shall be furnished to the district by the laboratory. I have read and understand the foregoing statement and have answered all questions truthfully.
CHAWANAKEE UNIFIED SCHOOL DISTRICT
North Fork, California