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Drug Testing Consent · Pro

Pre-Employment Drug Screening Consent Form

Collect applicant consent for drug and alcohol testing, specimen collection authorization, and medication disclosures before hiring with this ready-to-use form.

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Espresso theme

formbuilder.ai/f/pre-employment-drug-screening-consent-specimen-collection-authorization-form

Pre-Employment Drug Screening Consent & Specimen Collection Authorization Form

Applicant Full Name

· · ·

Date of Birth

· · ·

Phone Number

· · ·

Submit

The Pre-Employment Drug Screening Consent & Specimen Collection Authorization Form is a comprehensive digital form designed to help employers, HR departments, and staffing agencies legally and securely obtain applicant consent before conducting workplace drug testing. It covers the full scope of the screening process—from specimen type (urine, hair, saliva, or blood) to panel substances tested—ensuring transparency and legal compliance at every step.

This form is ideal for any organization that requires pre-hire drug and alcohol screening as a condition of employment. It captures applicant identification details, the position applied for, and employer information, while clearly outlining the applicant's rights, confidentiality protections, and consequences of refusal. Applicants also have the opportunity to disclose current prescription or over-the-counter medications that may affect test results, which are shared solely with the Medical Review Officer (MRO).

By using this structured digital form, employers can streamline their onboarding compliance workflow, reduce liability, and maintain consistent documentation across all candidates. The built-in medication disclosure section and MRO authorization make it a fully self-contained pre-employment screening solution that keeps your hiring process both professional and legally sound.

3 Pages

21 Questions

~7min To complete

Free No credit card needed

Field types Short Text ×6 Date ×3 singlecheckbox ×2 Full Name Phone Email Address richtext Long Text Yes / No Dropdown termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Applicant Information 9 questions

Applicant Information

Please complete all fields accurately. The information provided must match your government-issued identification.

1 Applicant Full Name * Full Name

2 Date of Birth * Date

3 Phone Number * Phone

4 Email Address * Email

5 Current Mailing Address * Address

6 Government-Issued ID Number (Driver's License or State ID) * Short Text

7 Position Applied For * Short Text

8 Hiring Company / Employer Name * Short Text

9 Department or Division Short Text

Page 2 Drug Screening Consent & Authorization 5 questions

Consent & Authorization for Drug Screening

Please read the following statements carefully before providing your consent. By signing this form, you authorize the collection and testing of a biological specimen (urine, hair, saliva, or blood) for the purpose of detecting the presence of controlled substances, drugs, or alcohol as a condition of employment.

1 **Scope of Testing:** The drug screening panel may include, but is not limited to, testing for amphetamines, barbiturates, benzodiazepines, cannabinoids (THC), cocaine, methadone, methaqualone, opiates, phencyclidine (PCP), and alcohol. **Confidentiality:** All test results will be treated as confidential medical information and disclosed only to authorized personnel involved in the hiring decision, the Medical Review Officer (MRO), and as otherwise required by law. **Right to Refuse:** You have the right to refuse to submit to drug testing. However, refusal to consent may result in withdrawal of the conditional offer of employment. richtext

2 Do you consent to the collection and laboratory analysis of a specimen for drug and alcohol screening? * singlecheckbox

3 Do you authorize the release of test results to the designated employer and Medical Review Officer (MRO)? * singlecheckbox

Prescription & Over-the-Counter Medication Disclosure

Please list any prescription medications, over-the-counter drugs, or supplements you are currently taking that may affect test results. This information will be shared only with the Medical Review Officer.

4 Current Medications / Supplements (include name, dosage, and prescribing physician if applicable) Long Text

5 Are you currently under the care of a physician for any condition that may affect test results? * Yes / No

Page 3 Specimen Collection Authorization & Signature 7 questions

Specimen Collection Authorization

By signing below, you confirm that you have read and understood the terms of this consent form, that all information provided is accurate, and that you voluntarily agree to submit a specimen for drug and alcohol screening as a condition of pre-employment.

1 Specimen Collection Method * Dropdown

2 Collection Site / Facility Name Short Text

3 Date of Collection * Date

4 Collector / Technician Name Short Text

5 I certify that I have read, understand, and voluntarily agree to the terms outlined in this Pre-Employment Drug Screening Consent & Specimen Collection Authorization Form. I understand that refusal to consent or a confirmed positive result may result in withdrawal of the employment offer. I acknowledge that the specimen collected is my own and has not been adulterated or substituted. * termsandconditions

6 Applicant Signature * Signature

7 Date Signed * Date

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.