Background Investigation Permission and Drug & Alcohol Testing
I, the undersigned applicant of Community Bus Services/BusTeam, residing at below stated address, have been advised and am fully aware that representatives of the above named company will be conducting a thorough investigation of my background to assist in determining my suitability for this employment, including making inquiries of: officials and records at schools which I attend; physicians and/ or other persons who may have examined or treated me for a ph ysical or other type of illness or injury; police or courts with who I may have an arrest or conviction record; present and previous emplo yers; other persons who may be able to provide information about me which the company desires; criminal background check with both Ohio BCI and FBI; and driving record from Ohio Bureau of Motor Vehicles. All of these inquiries are with my consent.
I hereby give my per mission and waive all provisions of law forbidding any ph ysician or other person who has attended me, or any other school officials, court, government or police agency, employer, form or person, from disclosing any knowledge or in formation they have concerning me which is reque sted or desired by the above named company. I further consent that the Superintendent or his / her representative be provided with a copy of such record concerning me, which they may desire.
I recognize the right of Community Bus Services/ BusTeam and the Board of Education, to treat at its discretion, certain sources as confidential, and its right to withhold from my agent or me the names of such confidential sources, and information obtained there from.
In addition, as an applicant of the company, I here by acknowledge that the company's policy requires me to submit to urine drug testing and/ or breath, saliva, or blood alcohol testing. I further understand the purpose of this analysis is to determine or rule out the presence of non-prescribed or prohibited dangerous controlled substances in my system.
I hereby freely and voluntarily con sent to this request for a urine sample and / or breath, saliva, or blood alcohol test, and agree to participat e in the testing program.
I hereby and herewith release the company, its employees, agents, and contractors from any and all liability whatsoever arising from this request for testing, from the actual testing procedures and from decisions made concerning my application for or continuation of employment based on the results of the analysis.
I agree to cooperate in all aspects of the testing program and hereby authorize the release of my drug and/or alcohol test results to the contractor's medical review officer, and/or the company's examining physician, as provided by the Policy.
I further acknowledge the company has pro vided m e with an opportunity to ask questions related to its drug and alcohol testing program, and it answered all my questions.