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I iso iaoorat, u sena of the test resorts n+te - Review Officer (MRO) chosen by
<br />rusuarvice xi5larniial. Ai��Pai tis? iE§u1Z writ til ac sem to ru3ALivice WSiOWtiat C][� as otherwise i5e taro. irkd in
<br />Lae rviicy_
<br />v my testi sty of inipcniiissame mcom or wept anig _..,., the ivitcV nma D, rusiaervicC
<br />Residwtial will telephone me at um uuumo t hare- on roca mm of% -I y iorm to unm — _,, oppominity protripu w
<br />pnrif* information to the MRO that the rest recuts ate [ witti icgai ding use or a numinte reason wn, Inc
<br />alcohol test results are positive.
<br />ifmy labora�t„y results showevidence orakohol ordlvg use and I do notprompuy proviac iniormation to am
<br />MRO that the test results are consistent with legal drug use or a legitimate reason why the alcohol iCSt FSMM are positive,
<br />the MRO will tell FirstService Residen.:al that the tea results were r, M'L;.T.
<br />It we alcatmllfflUs. �. i_:tive, I may have the original urine, hair andlor blood specimen retested at a
<br />Certitren l3D01711 ,,,�t ..,, gyp,.—, 1m.5..- the ,,,,,,.s,.tyofthe oril;ival3F . , is not..,,.,apromiscd.
<br />iI I= iaoomlo.-, of . WWl or aft -= crugzw� in my tests or t establish for the MRO that my
<br />rt57n6 are consistent wrtQ I—y,.1 � M 361- Alc F!RM _.., I will 00 passes the tz=M
<br />i tee mrcv win iiiiorm rirstaervrce res:ll M;_u,;; tie.«..—. KCSoluCes UepaTlment wnetner Mc to; results were
<br />negative or posiuve.
<br />Medical information and test results provided as part of ine Mg testing process win In maimainea Dy ule mKO
<br />in confidence and will be disclosed in accordance with the law, rositive or negative test resuits wiu De aiscinn I-
<br />FirstService Residential licrsonnel and other individuals who have a reasorsotc or iegisimate "need to Know or wnere
<br />I,ermitted by law. If, however, 1 directly or indirectly initiate a legal proceeding involving rirstaervice mesiuerxim in
<br />which such records are relevant, they will be disclosed to the extent permitted by law
<br />I a-derstand that this Aa.«mens is no, a contra" of un-w-loyutciu and without prejudice to Firs6crvice
<br />ttes.ac .tHH'., i,vlic, -f cnsyloy,,,ent at will.
<br />if I ice:[ me 3;__F -.titer i3cunal [cats, resardless of when or where the substance entered my sym,c.,—y tamlu with
<br />ine eoliect:w.-. t.... rm, o: ceruse to co;_—an[ 1-. cwrc mt� D, s:b.,..q; 10 1v,—., or fa:l to submit to the ,es[ at the time and
<br />piace scnetmuien ay nrsticirlew KcJaent...i, .t ,...., -..it i:, co,.—c<ji=c uel.u:., at, to entl rr...tuainb terminalion. l
<br />unaerstana carat iii test positive ana I a.: -at n:reel or r Z., 1CrMi-tM w a .....lt of ins i.... rove- tat, i Il ..ot nYpt, for
<br />employment wiui rirsiaervice nesitlentiai for at least i av mys. i runner—aerstantl i !1i 6c .rye:.ii to era-.�b�ui
<br />test result before i will oc permittee to return to wore.
<br />1 hereby authorize the medical and/or specimen correction iachity to uisciose an pertinent meaicnl
<br />and all laboratory results to a Medical Review Officer j `MRO't Eared or retainetl ay Pirswervice rcesitlentiai. me
<br />release by the medical and/or specimen collection facility of the information and results, anti the utilization or me
<br />information and results by the MRO shall be for a limited purpose ofproviding FirstService residential an opportunity to
<br />evaluate the resulw and thereby determine whether 1 am fit to perform my yob or the job for which l am considered.
<br />i is. authorize the MRO to disclose the les, results ;o FirstService Residential's Human Resources Depmmnen[.
<br />i nc .icaat: D, Inc mKU of test results and the utilization of these results by FirstService Residential shall be for the
<br />of plb-tai.-.b r: ,tsc-i-e Resiaenlial an opportunity to evaluate the resul. and thereby determine
<br />WneMer i ani 1:1115 r..r1VRTi -,,oD or mcwD far mnicn i coie.acsa.
<br />i also voiuntariiy as. -cc ut..t -if m, t zt, tat malts , w, De micusea 5, FirstService
<br />nesidentiai, its wietlicni rmeview vincer {mxv), empioyee ass:stance ,.:06......, I..Doralfl., wail mvi....cnts :n .n,
<br />adminietmtive, civil or otner iegai proceetling to Inc court or appropriate nea.-.ns oulcer, „ 'Aie..t:on or Lat rm..dcr ice.
<br />which 1 am a party which relates to my employment anu in wnica me resuirs of my orug test
<br />(13)
<br />LuKV3' landscaping, erre.
<br />L-4
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