Please Read Carefully Before Submiting

I hereby consent to submit to urinalysis and/or other tests as shall be determined by CCS Janitorial Service, Inc in the selection process of applicants for employment, for the purpose of determining the drug content thereof. I agree that a physician or clinic, assigned or hired by CCS may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the company for analysis. I further agree to and hereby authorize the release of the results of said tests to the CCS Janitorial Services, Inc. I understand that it is the current illegal use of drugs and/or abuse of alcohol that prohibits me from being employed at CCS Janitorial Services, Inc. I further agree to hold harmless the CCS Janitorial Services, Inc and its agents (including the physician or clinic) from any liability arising in whole or part out of the collection of specimens, testing, and use of the information from said testing in connection with the CCS Janitorial Service, Inc consideration of my employment application. 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.