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.