Author: parkss

SUMTER COUNTY SCHOOL BOARD
2680 WC 476, Bushnell, Fl 33513
PHONE (352) 793-2315 FAX (352) 793-2096

PS-137-A
Rev. 12/19

PRE-EMPLOYMENT CONSENT FORM FOR DRUG TESTING
BUS DRIVERS ONLY
I hereby consent to the testing for drugs and/or alcohol as shall be determined by the Sumter County School Board Policy in the selection process of applicants for employment, for the purpose of determining the drug and/or alcohol content thereof.
I agree that CONCENTRA, 210 South Lake Street, Suite 4, Leesburg, Florida 34748 may collect these specimens for tests and may test them, if qualified, or forward them to a certified laboratory designated by Sumter County School Board for analysis. I understand this testing must be completed within the same business day of receipt of this form. I understand that I must remain at the lab until a sufficient specimen sample has been provided. The cost of this test will be the employee’s responsibility. I further agree to and hereby authorize the release of results of said test to the Sumter County School Board.
I understand that any use of a controlled substance on my part may prohibit me from being employed by the Sumter County School Board.
I further understand that refusal to submit to testing, failure to promptly report for testing, or any attempt to delay or adulterate test results shall be considered a positive test finding and a violation of Board Policy.
I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.
I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.
Department of Transportation (DOT) Test Required
Applicant’s Printed Name: ______________________________DL#: ___________________
Applicant’s Signature: _________________________________________________________
HR Witness: ________________________________________________________________
Reporting Date: _____________________ Reporting Time: ________________________
To be completed by lab personnel only:

Signature acknowledging testing time and date: ____________________________________
Date: _________________________________ Time: ______________________________

ORIGINAL—LAB YELLOW—HR
~An Equal Opportunity School District~