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POLYGRAPH CONSENT
 

Name:

Date of Polygraph Examination:

I voluntarily agree to a polygraph examination on the above date.

A company representative has advised me of the following:

1) I am guaranteed by law the right not to take this examination as a condition of employment or
continued employment.

2) I have not been coerced in any way into either taking this test or signing this consent agreement.
This act is entirely voluntary on my part.

3) I have retained a copy of this agreement for my records.

EMPLOYEE COMPANY

Authorized Signature Authorized Signature

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