W
DEPARTMENT OF HUMAN RESOURCES
ENTRANCE DRUG/ALCOHOL SCREENING
I, ________________________________, having been given a conditional offer of employment
for the position of _____________________________________ do hereby authorize the College
of Wooster to set an appointment for a 10-Panel Drug/Alcohol Screening. This screening is in
compliance with the College of Wooster Drug-Free Workplace Policy.
If the drug/alcohol screening reveals a positive result, I understand that my conditional offer of
employment will be withdrawn.
I understand and agree to completely release and absolve the College of Wooster and its staff
members from all liability connected in any manner, either directly or indirectly, with this
drug/alcohol screening. Should I desire a copy of this screening report, it may be obtained from
the Center for Occupational Medicine.
I also understand that termination of employment for any reason within the first 90 days of
employment will result in the cost of the drug test being deducted from my last paycheck. If the
check does not cover the full amount, I will be billed for the remainder.
Signature of Applicant _____________________________________ Date ________________
Signature of Parent/Guardian ________________________________ Date________________
Signed in the presence of:
Witness ______________________________________________________________
1/03
H.R.O.
