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    AR-016E Drug Test Consent Form English

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    jacobtschel

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    © All Rights Reserved
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    AR-016E Drug Test Consent Form English

    Uploaded by

    jacobtschel
    22 views1 page

    Original Title

    AR-016E+Drug+Test+Consent+Form+English

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    22 views1 page

    AR-016E Drug Test Consent Form English

    Uploaded by

    jacobtschel

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Drug & Alcohol Testing Acknowledgement of Notice, Consent, and Release

    Form
    Kohl's Department Stores, Inc. (“Kohl’s) has provided me with a copy of Alcohol and Substance Policy
    150 along with a copy of Kohl’s Drug Testing Policy 126E (the “Policies”). I have reviewed the Policies
    and understand that Kohl’s offer of employment to me is conditional and expressly contingent upon my
    compliance with the Policies. I understand that Kohl’s may withdraw its offer of employment to me for
    any refusal or failure to submit to testing and successfully comply with the Policies. If I am already an
    Associate, I understand that my refusal or failure to submit to testing and successfully comply with the
    Policies may result in discipline up to and including termination of my employment with Kohl’s.

    I hereby consent to: (1) undergo drug and/or alcohol testing pursuant to the Company’s Drug and Alcohol
    Testing policies; and (2) communication of test results and test-related information by the laboratory, its
    agents, representatives, and employees to Kohl’s. I understand that a positive test result may result in the
    withdrawal of any conditional job offer made to me (if I am a job applicant), or discipline up to and/or
    including termination of my employment (if I am a current Associate).

    I understand that the clinic and laboratory will take every precaution which in their estimation will help
    ensure accurate test results. I understand further, however, that there is a possibility that a false-positive
    test result may occur. I hereby waive any and all claims and damages and release and discharge the clinic
    and laboratory from any and all claims and damages resulting from the disclosure of a false-positive
    result.

    I further understand that in the event my test results are positive I have the right to request, in writing, a
    confirmatory retest of the original sample, at my expense, at a testing laboratory that is statutorily
    authorized to perform drug and alcohol test analysis, provided that the request is made to the company
    within five (5) working days of my notification of the positive test result.

    I understand and agree that by checking the box of the electronic record to which this Acknowledgement
    of Notice, Consent, and Release Form is linked, I am acknowledging that I have seen and read a copy of
    the Company’s Alcohol and Substance Abuse Policy 150, along with a copy of Kohl’s Drug Testing
    Policy 126E, and that I voluntarily authorize, and consent to submit to, drug and/or alcohol testing.

    I further understand and agree that by declining to check the box of the electronic record to which this
    Acknowledgement of Notice, Consent, and Release Form is linked, I am refusing to submit to drug and/or
    alcohol testing, and am failing to comply with these policies in their entirety, which may result in
    withdrawal of my conditional offer (if I am a job applicant), or discipline up to and/or including
    termination of my employment (if I am a current Associate).

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