Notice of scheduling of polygraph

(Insert Date)

TO: (Insert Examinee's Name)

You are hereby notified that we have scheduled you for a polygraph test to take place at (location of test), on (date of test), 20, at (time of test.) YOU HAVE THE RIGHT TO OBTAIN AND CONSULT WITH LEGAL COUNSEL OR AN EMPLOYEE REPRESENTATIVE BEFORE EACH PHASE OF THE TEST.

Attached to this notice is a complete list of questions you will be asked during the polygraph test. Please review it prior to attending the testing session. YOU HAVE THE RIGHT TO TERMINATE THE TEST AT ANY TIME.

The nature and characteristics of the test you will undergo and the instruments involved are as follows:

(Describe the polygraph and the instruments that will be used during the test.)

The testing area contains:

• two-way mirrors

• cameras

• another device through which the test can be observed:

(Describe the device here)

Either you or we can make a recording of the test as long as we are both aware that this is being done. We ( ) do / ( ) do not intend to use a recording or monitoring device during the test.

We intend to use the following other devices during the test:

(Describe other devices here or write not applicable)

Signature

(Supervisor's signature)

For: (Insert Name of Company)

NOTE: This is only the notice informing the employee or applicant of the scheduling of the polygraph.