2024 Pre-Employment Drug Testing Consent Form for Minors - Waiver of Constitutional Rights and Consent

Sep 18, 2026

Burney Water District requires applicants, including minors, to submit to pre-employment drug testing based on provided consent and waiver terms. The form explains that urination will be performed at a designated collection site, with testing focused on specified controlled substances and immediate results. It states the applicant’s right to refuse, potential employment withdrawal for refusal, consent to sample collection and laboratory testing, and handling and reporting of results. It also describes consequences of positive results and outlines applicant and parent/guardian signature and contact fields.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Pre-Employment Drug Testing Consent Form

Types of Test and Requested Analysis

Collection Site and Testing Substances

Refusal Rights and Consequences

Consent, Result Release, and Record Handling

Positive Result Consequences

Signatures and Contact Information

Burney Water District 20222 HUDSON STREET, BURNEY, CA 96013 (530) 335-3582 Pre-Employment Drug Testing Consent Form Waiver of Constitutional Rights and Consent for a Minor to Participate in Drug Testing The Burney Water district is a drug free work place and wants to assure the safety, health, and well-being of its employees, including minors, in the employment of the Burney Water District. Type of Test: Job Applicant/Pre-Employment (drugs only) Request: I have been requested to provide a urine specimen for analysis from controlled substances. I understand that this analysis may indicate the presence of controlled substances in my system. Collection Site: I have been instructed to go to the Burney Water District on a date to be determined. Compliance Associate is the organization that will be testing the sample. They will be testing for Methamphetamine (mAMP), Opiates (OPI), Phencyclidine (PCP), Benzodiazepines (BZO), Barbiturates (BAR), Methadone (MTD), Amphenol (AMP), Cocaine (COC), and Marijuana (THC) . The drug testing process will be to urinate in a cup, it will need to meet temperature and then they will be testing it for the drugs stated above and the results are immediate. Refusal: I understand that I have the right to refuse to undergo testing for controlled substances. If I refuse, I understand that my application for employment will be immediately withdrawn from consideration. Consent: I consent to the urine sample collection as specified above. I also consent to testing for controlled substance by the laboratory referred to above and the release of the laboratory test results to a medical review officer and then to the Burney Water District. As a condition for an application to be considered, applicants must understand and agree to submit to a drug test. If the test results are positive, the applicant shall not be considered further by the Burney Water District for this recruitment. The Burney Water District will pay the cost of the pre-employment drug test. Any additional treatment or cost relating to the results of the testing shall be the applicant’s responsibility. The Burney Water District will maintain the results of the pre-employment drug test. Negative and positive results will be reported to the District Manager. Consequences: I understand that a positive test result for controlled substances will result in the withdrawal of any job offer that has been made to me if I am an applicant. I understand the above conditions and hereby agree to comply with them. I, hereby, give full consent for my minor child or dependent to undergo a drug test as a condition of employment with the Burney Water District. Print Applicant’s Name Telephone Number Address City, State, Zip Applicant’s Signature: Print Name of Parent or Guardian Address Telephone Number City, State, Zip Parent or Guardian Signature:

FAQs

What type of drug test does this consent form authorize?

It authorizes a job applicant pre-employment urine test for drugs only, using the controlled substances listed in the form.

What happens if the applicant refuses to undergo the drug test?

Refusal results in the immediate withdrawal of the employment application from consideration.

Who must provide consent for a minor and what information is required?

The applicant and a parent or guardian must sign, and both sets of contact and address information must be provided on the form.

Sep 18, 2026

Upload by Chloe Bennett