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The purpose of this consent is to explain the results of my drug test,when relevant,in any administrative,civil <br /> or legal proceeding. This consent shall be valid so long as any administrative,civil or legal proceeding relating to my <br /> employment to which I am a party continues. I agree that FhgSen,ice Residential and its agents shall not be held liable <br /> in any respect for providing the information I have requested as set forth above. <br /> I acknowledge that executing this Authorization is vvhsntary and that I have the right to receive a copy of this <br /> Authorization if I request one. <br /> I understand I may ask questions about the tests. I understand that this is a summary of FirstService <br /> Residential's Drug and Alcohol Abuse Policy and that the full Policy governs my testing. <br /> AFTER READING THIS FORM,CONSIDERLNG THE POSSIBLE CONSEQUENCES OF MY CHOICES,I <br /> FREELY AND VOLUNTARILY: <br /> AGREE AND CONSENT TO BE TESTED UNDER FIRSTSERVICE RESIDENTIAL'S DRUG AND <br /> ALCOHOL ABUSE POLICY. <br /> Date: <br /> EMPLOYEE SIGNATURE <br /> EMPLOYEE'S PRINTED NAME <br /> Date: <br /> MANAGEMENT REPRESENTATIVE SIGNATURE <br /> #3389824 vi <br /> [14] <br /> Lukes' Landscaping, Inc. <br />