PRE-EMPLOYMENT DRUG CONSENT & RELEASE FORM

I hereby consent to submit to urinalysis and /or other tests as shall be determined by Titan Pallet Company, LLC in the selection process of applicants for employment, for the purpose of determining the drug content thereof.

I agree that either NOVA Medical Centers, 2781 Airways Blvd., Memphis, TN 38132 or Concentra Urgent Care of Memphis at 2831 Airways, Blvd., Suite 102, Memphis, TN 38132 may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the company for analysis.

I further agree to and hereby authorize the release of the results of said tests to Titan Pallet. I understand that it is the current illegal use of drugs and/or abuse of alcohol that would prohibit me from being employed at Titan Pallet.

I further agree to hold harmless Titan Pallet and its agents (including Concentra, NOVA and their MROs) from any liability arising in whole or part out of the collection of specimens, testing, and use of the information from said testing in connection with Titan Pallet’s consideration of my employment application

I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force as the original.

I have carefully read this document and fully understand it. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.

***Titan Pallet will pay for drug screenings done at Concentra or NOVA. If you work at Titan Pallet for less than 90 days the cost (currently $76.85 for rapid results testing, and an additional $67.02 if further testing of the sample is necessary) of the drug screening will be deducted from your last paycheck.