“I hereby consent and agree to give a sample of my urine and/or blood for alcohol/drug screening at the request of Insights. I authorize the laboratory and physician to release my medical information to Insights for the purposes

of determining legal drug use or other medical factors, w h i c h may affect this Policy. I further agree to hold harmless the Company, its employees, agents, doctors, and any medical clinic, hospital or laboratory it

designates, from all liabilities arising from the use of such information as defined in the Policy. I understand that all medical, drug, or alcohol information will remain confidential and will only be released according to the

Policy. The submission of this electronic application acknowledges that I have read and understand the foregoing statement, and I have answered all the questions truthfully.”