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To: (Employee Name)
Date:
Pursuant to the Employee Polygraph Protection Act
of 1988, you are hereby requested to submit to a
polygraph exam (lie detection test.) Please be
advised that you have 48 hours, excluding weekends
and holidays, to consult with an attorney (lawyer)
or an employee representative before the scheduled
exam. |

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By law, you cannot be required to submit to any polygraph
examination. You will not be terminated or penalized for
refusing to take this examination.
This test is administered in connection with an ongoing
investigation specifically involving: (Example- missing money
from weekend drop box)
You had access to the property, money, merchandise, inventory,
parts (circle one) that is the subject of this investigation
because: (Example- employee had assigned keys to the
storeroom)
We have reasonable suspicion of your involvement in the above
described incident, based on the following: (Example-
co-worker witnessed improper activity)
Signed/ Dated by Employee Employer (Company Representative)
Contact Lie Detector Tests, Inc. today for more
information on how we can assist you in gaining truthful
information regarding legal issues or allegations of interest
within your business or personal life. |