CITY OF CHUBBUCK
INTRODUCTION TO APPLICATION PROCESS
CONSENT AND RELEASE OF LIABILITY
THE CITY OF CHUBBUCK HAS ADOPTED AN ALCOHOL AND DRUG FREE WORKPLACE PROGRAM. THEREFORE, ALL PROSPECTIVE NEW
HIRE EMPLOYEES, UPON AN OFFER OF EMPLOYMENT, WILL BE REQUIRED TO TAKE A PRE-EMPLOYMENT DRUG TEST (RESOLUTION#9-95).
I understand that before being employed here and according to the Drug/ Alcohol Free Workplace Program, 1 will be required to undergo a drug screen or test, which includes a specimen of my urine for chemical analysis for testing purposes. I understand that this analysis will be conducted by qualified laboratory personnel. The purpose of this analysis is to determine or rule out the presence of non-prescribed or prohibited controlled substance(s) in my system.
I consent freely and voluntarily to this request for a urine specimen. I hereby and herewith release the City of Chubbuck, its representatives, and qualified laboratory personnel and their employees of any liability arising from this request to furnish the specimen, the testing of the specimen and decisions made concerning my application for employment or continued employment based upon the results of the analysis. I understand a documented chain of specimen custody exists to ensure the identity and integrity of my specimen throughout the collection and testing process.
THE CITY OF CHUBBUCK REQUIRES A BACKGROUND CHECK ON ALL PROSPECTIVE NEW HIRE EMPLOYEES.
IF YOU DO NOT WISH TO WORK UNDER THE ABOVE POLICIES, PLEASE DO NOT FILL OUT THE ATIACHED EMPLOYMENT
APPLICATION. AFTER READING THIS PAGE, IF YOU DO WISH TO PROCEED FURTHER AND FILL OUT AN APPLICATION, PLEASE
ACKNOWLEDGE THAT YOU HAVE READ, AGREE AND UNDERSTAND THESE STATEMENTS BY YOUR SIGNATURE BELOW.