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 the 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.



Signature _________________________________

Date______________________