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JOHNSON-DAVIS INC. 606 N6l.ORATH DRIVE LANTANA, FLORIDA 33662.160{ SEI -606.1170 FAX 661.606.5262 cu-COa3007 DPW -2 CONSENT TO AUTHORIZE JOB A.PPLICANVEMPLOYEE TESTING By placing my initials in the blanks below, and by signing and dating this form, I consent to take the Drug and Alcohol test(s) and authorize release of any test results to this Company. I understand that I may be placed on a temporary leave of absence pending results ol'said test(s). I further understand `i that if I am requested to test as an applicant, should my test(s) results be confinned positive, my application for employment will be rejected and if I am requested to test as a current employee, should my test(s) results be a confirmed positive, I will be terminated immediately. 1 also understand that if I refuse to submit to a drug test, I may be disqualified from hiring consideration. 1 have been informed through this consent form that Florida Statutes §§ 440.101- 440.102 governs drug testing and notice requirements in the State of Florida for employees of public and private employers. By signing below, I hereby. authorize the release of the results of the test(s) to which 1 have consented. I further authorize this Company to discuss the results of the test(s) with the medical personnel/physician collecting the specimen, the testing facility, its directors, officers, agents, and employees responsible for administering the aforementioned test(s) or evaluating the results thereof and any of them herein and to use the test results as a defense to any legal action to which I ain a party. I understand the above stated policy and hereby give my consent to the Company to administer drug and alcohol testing, which may consist of the taking of blood, urine, breath, saliva, or hair samples from my body, or any other medically accepted test designed to detect traceable amounts of drugs, controlled substances, and alcohol in the body. I also understand that I can confidentially report to a Medical Review Officer the use of prescription or nonprescription medications before and after being tested.