Notice of Polygraph Test...


PREPARED ON YOUR COMPANY LETTERHEAD


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NOTICE OF POLYGRAPH TEST

TO: NAME OF EMPLOYEE
      ADDRESS
      ADDRESS

Date Notified:

FROM: Name of Company Official

SUBJECT: NOTICE OF POLYGRAPH EXAMINATION IN COMPLIANCE WITH THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 AS AMENDED.

This memo constitutes your 48 hour notice and you are hereby requested to cooperate with a polygraph examination as part of an on-going investigation. Your appointment time is _____ _.m. The examination will be conducted by Dallas Polygraph Services, which is located at 9330 LBJ (635) Freeway, Suite 900, Dallas, Texas 75243 (Greenville Ave. or Abrams Rd exit LBJ and stay on frontage road to Prosperity Bank tower and go to 9th floor). There is a map on the contact page at www.dallaspolygraph.com. Their office phone number is (214) 438-3880.

We have already retained the Licensed Polygraph Examiner and paid for your scheduled appointment time so should something happen to disrupt your schedule, please notify the lab and re-schedule at least two hours before your appointment. Your examiner will be A.D. "Skip" Ensley or other designated licensed examiner.

1. The examination will address specific questions that have arisen from our ongoing investigation. The facts are: [Employer will describe the economic loss or injury to the employer's business]

2. You had access to the [property, codes or controls, etc] and [again using the checklist, the employer will describe the employees access to the source of the loss] cash at all times while employed from _______ through ________ and this is the subject of this investigation because you had keys and were scheduled and did work during these times.

3. Reasonable suspicion of your involvement in the described incident is based on the following facts: [employer will describe the details of the reasonable suspicion] Define the purpose of the investigation, including economic loss or injury to the employer's business:

Example:

The Sylvania wide screen television model SYL409 valued at $900.00 was discovered missing from the employee day room in warehouse 4 on or about Saturday, January 5, 2001. You were the only employee on duty in that area on that day and you had master key cards to the warehouse. When first asked about the missing television you stated that you did not enter warehouse number 4 but the electronic card key system logged you in and out on that same shift.

The polygraph test will include questions furnished and reviewed with you by the examiner prior to the test.

You will not be asked questions about your religious beliefs or affiliations, opinion or beliefs as to race, politics, sexual behavior, union or labor organizations, questions designed to degrade or needlessly intrude into your personal life, or other questions not previously provided immediately prior to the in-test phase.

During the examination sensors will be placed on your body, so for that reason do not wear any bulky clothing and please wear shoes that you can easily slip off. The instrument used will be an electronic instrument that records changes in your cardiovascular, respiratory, and electro-dermal patterns for the purposes of rendering a diagnostic opinion on the truthfulness of your responses. The examiner will review with you the nature and methodology of the polygraph examination. The examiner will also review each and every question with you in advance of the in-test phase. You will have an opportunity to further explain any of your answers and you will be advised of the results of your examination immediately following the test.

A two-way mirror, camera (s) or other monitoring and recording device (s) may be installed in the polygraph laboratory (testing area) through which the examination may be recorded and/or observed by legal counsel or other representatives. Either you or the Company (your employer) may make a recording of the test. If you or your representative plans to make a recording of the test, please contact A.D. "Skip" Ensley at Dallas Polygraph Services at (214) 438-3880 to inform him of your plans prior to appearing for the exam.

The Polygraph Examiner and management wish to give you every opportunity to have a successful positive examination. For that reason, you are asked to get good rest, eat lightly, and refrain from any alcohol or non-prescribed drugs for a period of 24 hours prior to the examination. The Polygraph Examiner asked that we inform you that this will be a non-accusatory examination process.

If you do not consent to the examination, we will make our decision concerning your possible involvement in the activity under investigation, based on all relevant information available.



________________________________________________________________________
Employee Signature                  Date

_________________________________________________________________________
Company Representative Signature (Name of Official)         Date

SERVICE:

_________________________________________________________________________
Time                   Date                   Person Delivering Notice