Building Blocks Unlimited has a vital interest in maintaining a safe, healthful and efficient working environment for all of our Employment Seekers. We recognize that a company's future is dependent upon the physical and psychological health of each employee. Consequently, it is the company's obligation and intent to aid and safeguard that environment, and to protect the company's property, equipment and operations, accordingly.

With these basic objectives in mind, Building Blocks Unlimited has established an Employment Seeker Medical Evaluation Program to ensure that Employment Seekers are capable of contributing their best to the company. When presence of a physical impairment of significance to prevent fulfilling job requirements/duties is detected and verified, employment by the company may be denied. When presence of an illegal drug is detected and verified, employment may also be denied.

The following release form authorizes Building Blocks Unlimited to proceed with the evaluation of your application which may include requesting a drug/alcohol test. Failure to comply with the request of a medical evaluation may result in denial of employment opportunities in various companies.


I have been informed of the Employment Seeker's Medical Evaluation Program required by Building Blocks Unlimited, and have given my consent to undergo the medical testing deemed necessary to qualify me as a prospective Employment Seeker.

I further give consent to any testing agent to release test results to the above company.

I further give consent and authorize the release of any and all personnel, vocational, medical, psychological or psychiatric records to the above company.

I understand that the acceptance of my Employment Seeker's application, work records and medical records may be conditionally or unconditionally accepted by the companies.

________________________ ___/___/___
Employment Seeker's Signature Date

________________________ Printed Name

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