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rrr'{rLV Y M. AN V Arr"S_AS 1 U10-MbUN I
<br />avlfKUGAr«snreeAi.�4Vl1vL ids APIA
<br />AU l 0l.lKi_ i lV1r r V![
<br />RELEASE OF DIFORMATION
<br />READ TI IS FORM CAREFULLY
<br />i iso nereo, oerthy 5 -at i na z .....jived and read FisstService Residential Florida, Inc.'s ("FustService
<br />icesioentian Lnn-rree worspi...,. and Policiestit�t tngtng Substance Abuse mid 5creEHmg for Substance
<br />ADu3Z
<br />1 meely atm Votunsasiry agree to sno t to » wu,, :, oraMu,....i.te i.,r..0 esus. czccpt alcohol
<br />[alCOhDI to OC is sirn oy orooa or oreaui sampie] :i n quffea, - pori of .:1 :;71 Cat - I— =TJO,......L I tMerstand that
<br />Cither lefLtShc l4 submit [O is1C urug screen Or iariure i0 quw- �corattig [ii [ue ..«.»w...... statlo.7rns NiaDwsneo by
<br />FustSer ice Residential for this screen may t Mgi_miFy me /rota Itmeratio. In.- engw,.......L
<br />I further understand than after employment begins with rirsi3mvice mmiffential, i may again oe requM to
<br />submit to a drug screen. I understand that refusal to Mke a requested nnag sm= or iahurc to meet rna minimum
<br />standards set for the screen may result in immediate suspension or discharge.
<br />I understand that if I Im-uper with or fail the 1=, i may not be employed, and if an employee, will be subject to
<br />..i.p...r.:ste corrective actiom., up to and includin6 disc, or a, FirstScrvice Residential's sole discretion; required to
<br />e.,.,.rl, [n M. tertm of a last chance a&. cement.
<br />i zodwstauil ,nau a-vart any druy, conviction within rive day. from Me date of conviction.
<br />r irsmervi-e ►cestamm.tiat trio, rer.,rt the eon==doe. to W., Mc -i, .tote � local asency with which the employer has a
<br />contract anti is osr� requM oT to- to .=r -R A rw:iole 6.sort.. l l�tlb ol,v :. , result;.. co[recti-..ction.
<br />I understand -sat an information, interviews, reports, statements, -zWW=3 . » .8�iir s -C tcot rc:r--tts W.P
<br />the FirstService Resideniial's Drug i esting rrogram are condaentim communications a .a-..,-.vI oo v=u z.tcm i
<br />consent to release of such information oras offErwise requM or udowcu in accoruance wiQl slate a..a itll.mi
<br />regulations.
<br />will be directed to provide a urine, breath, hair and/or blood specimen at a medical or specimen collection
<br />facility chosen by FirstService Residential.
<br />1 R u be Gtlo-8 to provide a urine M=imen privately except that if I appear to be uyinb to provide a
<br />AMI:tu[ed, r.lietea, or cc3ette-ted ,p--imen, or have attempted ,o provide such a specimen previously or otherwise.
<br />I i erpe... to De »rte-rt6n6 [o t.. p...,:tn Cis a..uee.:o., erocew, I may be required ;o provide an observed
<br />specimen antuor suo eci to or ai ten .
<br />i will De anoweti, ii t noose, to ai,..ry o e.-...., oo,., of me Cn..i.. o1-Cwtv3, forte z., :caseation 1 use.
<br />after collection, my urine, hair antFor 'Dish specimen will De sent to .. I»DOMIo.-, cVlwucr. D, r: ,taervieu
<br />mesitlential to tesi for tletectaole amounts ofco.:trouea suvst» .rvz, :.GI»�i.-.a .—.-�—.., eve»:, a „rnet..-in.s, PCP,
<br />and/or opia Les.
<br />My urine; breath, and/or blood also will be tes-led to determine whether the presence of alcohol in my system
<br />.yuals or exceeds .04 percent or whatever level is set by the particular state or local laws where I work.
<br />1121
<br />Lukes' LnAbuapiiig, Ilic.
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