Pre-Employment Controlled Substance Consent Form

I understand that as required by the Federal Motor Carrier Safety Regulations, Title 49 United States Code of Federal Regulations, Section 391.103 and BXB Express Freight Inc company policy, all prospective drivers must submit to a controlled substances test.

I agree to provide a urine sample at a location and time designated by BXB Express Freight Inc, to be tested for controlled substances.

I also understand that if I test positive for use of controlled substances, I am not medically qualified to operate a commercial motor vehicle or perform safety-sensitive functions.

I also understand that the results of the controlled substances test will be examined by a Medical Review Officer who will report the test results to BXB Express Freight Inc and/or its screening agents, including ,__,. My results will not be released to any additional parties without my written authorization.

I agree to hold harmless BXB Express Freight Inc and its agents from any liability with regard to the collection and testing of my specimens, or the use of my controlled substance test results in connection with my employment or consideration for employment.

Name Signature Date _______________________ _______________________ _______________________