Laserfiche WebLink
T. George Podell & Co., Inc. may request proof that I am taking a controlled substance as directed <br />pursuant to a lawful prescription issued in my name. If requested, I agree to provide such proof within 72 <br />hours. <br />I have the right to request a re -test of the initial specimen at a licensed laboratory of my choice if and <br />when I have a positive test for drugs. All requests for a re -test of the sample must be made within ten <br />(10) working days of the receipt of the original positive test result. The results of the samples must be <br />forwarded to me by the appointing authority of the licensed laboratory. <br />I further understand that a positive test, refusal to authorize this form, refusal to take the test, or failure to <br />produce a specimen, may result in disciplinary action up to and including dismissal in accordance with <br />any local, State, or Federal statute, regulation, and policy. <br />Employee Signature <br />Date <br />Print <br />