APPLICANT CONSENT for DRUG SCREENING

As part of PlanIT Group client commitment to a drug-free work environment, all applicants
will be requested to take a urinalysis drug screening.

These tests will be conducted by a SAMHSA certified laboratory and personnel selected by
PlanIT Group. Test results will be completely confidential. I understand that this information
may be released to the client or agency for whom my services are being utilized as part of my
pre-employment screening or as contractually required.

Applicants with "positive" test results will be informed of their results and will be denied
placement.

I agree to take a urinalysis drug screening as part of my placement consideration, and understand
that I will be denied placement if my test results indicate as "positive". I also understand that I
may be requested to take a drug test at any time after my placement with a client of PlanIT
Group.

I release PlanIT Group, its’ client(s) and and/or its agents from any claims or liability resulting
from the administration and reporting of results of my drug test.

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Applicant Signature Date

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Print Name

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Social Security Number

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Date of Birth