Variety Children and Family
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AUTHORIZATION FOR DRUG &ALCOHOL SCREENING 109

Programs
AUTHORIZATION FOR DRUG &ALCOHOL SCREENING 109

VARIETY CHILDREN & FAMILY SERVICES INC

AUTHORIZATION FOR DRUG &ALCOHOL SCREENING

I  consent and give hereby authorization to Variety Children & Family Services ( A Human Services Agency) to subject me to Drug and Alcohol Screening as a  prerequisite for becoming a foster parent or seeking for employment with the agency and on any suspicion thereafter if I am certified as a foster parent or offered an employment position with the agency.

Authorization For Drug & Alcohol Screening
Name
Name
First
Last
Applicant/Employee Signature
Phone Number
Date

VCFS 0074/11-14