Polygraph Notice Acknowledgement Form
Please review the polygraph examination information below and confirm your acknowledgment of notice and understanding.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Role or Relationship to Organization
Examination Context or Reason
*
Scheduled Examination Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Examination
I acknowledge that I have received notice of the polygraph examination and understand the information provided.
*
I acknowledge and understand the polygraph notice.
Signature
*
Date of Acknowledgment
*
-
Month
-
Day
Year
Date
Submit Acknowledgement
Submit Acknowledgement
Should be Empty: