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Attachment D <br />BUILDING AND CONSTRUCTION RESOURCE CENTER INC <br />AUTHORIZATION FOR CONSF.NTTO DRUG AND ALCOHOL <br />ANALYSIS &AUTHORIZATION FOR RELFJISE OF RESULTS <br />1, the undersigned, do hereby authorize the testing <br />of my body fluids for employment reasons and understand and agree that the results <br />of any such testing %ill be turned over to the Building and Constructions Resource <br />Ccntcr, Inc. and, Guthrr that the testing procedures will be limited to tests for <br />prohibited and illegal drugs and controlled substances. <br />I understand that the results of these tests may be used for employment and <br />disciplinary reasons and hereby authorize the release of such information firm <br />the laboratory 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 />exclusively to the grievance and arbitration procedure under my collective <br />bargaining agreement ('rfapplicable). <br />Wan= <br />Datc <br />rune <br />Notary pubUc <br />Commission Expires <br />Official ScA <br />(Mast be notarized ifNOID) <br />Sigm =ofAppLandEmplgce <br />Emphlres SodZ Seaaity Number <br />Empigce's Telcphane Number <br />Emploleds Address <br />City <br />State & Zip Code <br />47 <br />