DISCLAIMER

Upon submission of this form I acknowlegdge that my card will be charge $85.00 for a 12 panel drug test and background check.

I understand that I will receive an email within 24 hours with an attached document with information regarding where to take my drug test and the results of my background check. 

I understand that this test is NON-REFUNDABLE.
NATIONAL BACKGROUND AND DRUG SCREENING CONSENT FORM
STUDENT FIRST NAME
CURRENT ADDRESS (PLEASE INCLUDED CITY, STATE & ZIP
EMAIL ADDRESS
DAYTIME NUMBER
DATE OF BIRTH   (MM/DD/YY)
MIDDLE NAME (If no middle please type NONE)
LAST NAME
NAME OF SCHOOL
YOUR CARD WILL BE CHARGED
Drug & Alcohol Testing Center
(404) 963-5767
TEL : (404) 963-5767             FAX: (866) 485-7070              email: [email protected]
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