Polygraph Consent

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Polygraph Examination Consent Form

I, {{employee_full_name}}, hereby acknowledge that I am employed by {{company_name}} (hereinafter referred to as 'the Company') as a {{employee_position}}.

Purpose of Examination

I understand that the Company has requested my participation in a polygraph (lie detector) examination. This examination is in relation to an ongoing internal investigation concerning {{reason_for_examination}}.

Voluntary Participation

I understand that my participation in this polygraph examination is entirely voluntary. I acknowledge that I have the right to refuse to participate in this examination, and that my refusal will not result in any adverse employment action against me, provided such refusal is not in violation of any applicable laws or employment agreements.

Waiver of Rights

I acknowledge that I have been informed of my rights regarding polygraph examinations as stipulated by applicable laws and regulations in my jurisdiction. By signing this form, I voluntarily waive any rights I may have to object to or refuse this examination.

Confidentiality

I understand that the results of this examination will be kept confidential and will only be disclosed to authorized personnel of the Company and, if necessary, to legal counsel or law enforcement agencies as required by law. I also understand that the results may be used in disciplinary proceedings or legal actions related to the ongoing investigation.

Examination Procedure

I understand that the polygraph examination will be conducted by a qualified and certified polygraph examiner. I consent to answer truthfully all questions posed during the examination relevant to the investigation into {{reason_for_examination}}.

Statement of Consent

By my signature below, I affirm that I have read and fully understand the terms and conditions outlined in this Polygraph Examination Consent Form. I freely and voluntarily consent to undergo a polygraph examination without duress or undue influence.

Legal Counsel

I acknowledge that I have been advised of my right to consult with legal counsel regarding this consent form and the polygraph examination, and I have either done so or voluntarily elected not to do so.

Signature Block

Employee Full Name: {{employee_full_name}}

Employee Signature: _________________________ Date: {{signature_date}}

Witness Full Name: {{witness_full_name}}

Witness Signature: _________________________ Date: {{witness_signature_date}}

Examiner Full Name: {{examiner_full_name}}

Examiner Signature: _________________________ Date: {{examiner_signature_date}}