Name of Attorney/Agency Requesting Exam:
I
,being
years of age,am fully aware and understand that I am to be given
a polygraph examination by Stephen D.Cabler,
licensed Polygraph Specialist,licensed by the Texas Department of Licensing
and Regulation.
I understand that the polygraph examiner will discuss with me all aspects and subject matter upon which I will be tested during the polygraph
examination.I understand that I shall be tested on the areas and subject matter discussed in the interview which
precedes the actual test and I have no objection to the entire examination being recorded.
Having been fully advised and with full knowledge and understanding of all above,I hereby voluntarily consent to this
examination of my
own free will and state that no duress, threats or coercion have been placed upon me to participate in
this examination.
I have not been promised anything of value, reward or immunity to induce me to consent to this examination.
I understand that I have the right to stop my polygraph examination at any time I desire.
I further understand that the results of my examination will be made available to the agency or investigating officials
that requested the examination.
I Also Understand That IF The Object Of The Examination
Is Sexual In Nature,I Will Be Asked Questions Of A Sexual
Nature That Are Pertinent To The Examination And The
Investigation.
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