Drug Test Consent Acknowledgement Form


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Release of Test Results: I agree that positive drug and/or alcohol screen test results be made available for review by the medical review officer (MRO), the company, and the Texas Department of Licensing and Regulation (TDLR) in connection with determining whether I violated the drug and/or alcohol testing policies established by 16 Texas Administrative Code, Chapters 85 and 86 (the Rules).. Printed Name of Applicant or Employee Signature of Applicant or Employee Applicant’s Social Security Number or Licensee’s TDLR License Number Date Texas Department of Licensing and Regulation Model Drug and/or Alcohol Testing Policy Consent Form Tow Operators and VSF employees must include their TDLR license number.


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