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Attachment D <br />BUILDING AND CONSTRUCTION RESOURCE CENTER INC. <br />AUTHORIZATION FOR CONSFNTTO DRUG AND ALCOHOL <br />ANALYSIS &AUTHORIZATION FOR RELEASE OF RESULTS <br />I, the undersigned, -do hereby authorize the testing <br />of my bod} fluids for employment reasons and understand and agree that the results <br />of any such testing will be turned over to the Building and Constructions Resource <br />Center, Inc and, hather that the testing procedures will be limited to tests for <br />prohibited and illegal drugs and commllai substances. <br />1 understand that the results of these tests may be used for employment and <br />rl <br />cU ' linary reasons and hereby authorize the release ofsuch information from <br />the aboratory and MRO. <br />I further certify that the urine specimen collected from me is mine and not <br />adulterated or altered in any manner. I have been advised that matters affecting <br />me relative to the interpretation or application of the Drug Policy and subject <br />cxdusively to the grievance and arbitration procedure under my collectivc <br />bargaining agreement (ifapplicable). <br />Witness <br />Datc <br />emu <br />Notary public <br />Commission Expires <br />Offidal Seal <br />(Must be tmruized if NO ID) <br />Signature ofApplicant/Employce <br />Employees Scdzl Security Number <br />Employees Telephone Number <br />Employees Address <br />City <br />Statc & Zip Code <br />47 <br />