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L tirLV xzt. ASU ArrLtCAiv r CONSENT
<br />L U lJJ[Uls Al410fVK ALCUriUL 114,1 AiYtl
<br />nU J HUJRIz�A J Jv►v r Vim
<br />RELEASE OF [NFORMA110N
<br />r-J:AIJ l IJJS rU"I CAKLVULLf
<br />I do hereby certify that I have received and read rirstService Kesitleaial ria da, IM.', ("F: 7-.IscR4cc
<br />Residential") Drub -Free Workplace Program and Policies regarding auostance rtnuse anti acreem.-.g to.- a--o,t...-.vc
<br />An:,zc.
<br />i beery anti vo,uat .=,, sr~� to ago -;t to .. arrb a., �-n-urinalysis or hair sample for all drubs excup, alcohol
<br />tatcohoi io oc tes= Dy wootl or oreatn if. �., �ti, , � part at , ..rruc„tion for emrlo j,,.eni. I understand that
<br />either refusal to submit to the drug screen or inhure to -,u-liry =eeera:-, to tnc -t-;-A-rds established b,
<br />FirstService Residential for this screen may disqualify me from tuf ler consitierati-ae 11e; ,.io,...o.-.t.
<br />i turth.r understand that after employtt,ent begins with FirstService Residential, J may again oe requirea to
<br />weo :t [e » i ws =Zen. L e.:d. 3ta.-,a tn..t rr.11=1 to take a r<yues,ed drug screen or failure to meet the minimum
<br />stantiaru—s set rbr tMe scree.. ma, moult :.-, :,—eH:J. jmmion or discharge.
<br />I understand that if i tamper wim or Tail lire iesm, i may not of -r1o, M, ..na :t an ciaplo.,-c, will be subject to
<br />appropriate corrective action, up to and including discnarge, or at rirstaervice Kesitie.ti»i'., .,etc ti:acr�t:o ., to
<br />comply with the terms ofa last chance as, cement.
<br />I cnlIcrat.pn that 1 shall report any drug conviction within five days from i„e Date or conviction.
<br />r irsizervice R:es:tie-.tial 1114, .vport tnc eoe::ctior. to r,,,, IAA Wil, -taa: or local agency with which the employer has a
<br />contract anti is OlnerwlSe fequlreo 6y IoW to. -v, -rt. A ro:1e.-e to .-eperi Z arab cUR:'.1iaimay result in corrective action.
<br />I understand that all information, interviews, reports, statements, memoranao .a til4v-tree teat rc..wtts tnroegn
<br />Fac FirstScrvice Residential's Drub Testing Program are confidential communications anti may not tie useti unless t
<br />eo we .t 1�x1e. �e et seen Information or as otherwise required or allowed in accordance with state and fetierai taws anu
<br />reguiat:ons.
<br />will be dirccleti to provitle a urine, EreaM, n..:: a.tiler olootl apccI cn ..l .. m.dical or specimen collection
<br />facility chosen by FirstService Residentiat.
<br />i it S. alto --ed ;o provide a urine specimen privately except that if J appear to oe trying to provice a
<br />..4o,titwtoil, ..rte -ti, or Acitc-1A .,p-cimen, or have attempted to provide such a specimen previously or otherwise.
<br />Ji J appear to oe anempting to to ;per ---:in- Mc ooticcu-z. rrb cis, 1 m.y be required to provide an observed
<br />specimen and/or subject to corrective action or tiisenarge.
<br />I will be allowed, if l choose, to disclose on my copy of the main of Cuslotly form
<br />Aire: coltcct:o,., m, urine, hair and/or blood upecimen will be sent to a laboratory chosen by rirsrService
<br />Kc�Ae.1L.1 tv tc:[ ioracicc;„dlc a....znts ofcontrolled substances, including marijuana, cocaine, amphetamines, rer,
<br />angor opiates.
<br />Mx urine, breath, and/or blood also will be teslell to uetermine wneQler Me presen.e w-it:onei I.-. -, s,slcm
<br />equals or exceeds .04 percent or whatever level is set by the particular state or local laws wnere t %%VT
<br />[12]
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