POLYGRAPH EXAMINATION REQUEST

Dear ____________________________,

Pursuant to the Employee Polygraph Protection Act of 1988, I am hereby
requesting that you submit to a polygraph (lie detector) examination.

    PURPOSE OF EXAMINATION
An investigation is in progress regarding an economic loss or injury suffered
by your employer.  The specific incident under investigation is
________________________________________________
_________________________________________________________________
________________________________________________________________.
You had access to the property in question as follows:  _________
________________________________________________________________.
In addition to mere access, your employer has a reasonable suspicion that you
were involved in the incident or activity under investigation for the
following reason(s):  _____________________
_________________________________________________________________
________________________________________________________________.


    EXAMINATION SCHEDULE
Your polygraph examination has been scheduled on ________________
at ___________   .M. at the following location:  ________________
________________________________________________________________.

    NATURE OF THE EXAMINATION
A polygraph instrument is a device which records continuously, visually,
permanently, and simultaneously changes in your cardiovascular, respiratory,
and electrodermal patterns.  These recordings are obtained by attaching
sensors to the body at the torso, arm and fingers.  The polygraph is used for
the purpose of rendering a diagnostic opinion regarding the honesty or
dishonesty of an individual.  Test questions are designed by the examiner
during the pre-test interview and are reviewed with you prior to the testing
phase.  The polygraph recordings (charts) are later analyzed and an opinion
is rendered based solely on these charts.

    DISCLOSURE OF INFORMATION
The polygraph examiner may disclose information acquired from your polygraph
test only to you, your employer or any court, governmental agency,
arbitrator, or mediator, in accordance with due process of law, pursuant to
an order from a court of competent jurisdiction.  Your employer may disclose
information from the test to a governmental agency, but only insofar as the
disclosed information is an admission of criminal conduct.

    TEST RESULTS
The examiner will transmit the test results to your employer following the
examination.  Prior to any adverse employment action by your employer, you
must be provided with a written copy of any opinion or conclusion rendered as
a result of the test, and with a copy of the questions asked during the test
along with the corresponding charted responses.  Also, your employer must
further interview you on the basis of the results of the test.  The results
of this polygraph examination may not serve as the basis for an adverse
employment action without additional supporting evidence.  Any statements
made by you during the test, however, may constitute additional supporting
evidence for the purposes of an adverse employment action. 

        MONITORING OF THE EXAMINATION
Your polygraph examination may be observed or recorded.  You must be advised
if this is to take place.  The below-indicated devices or techniques will be
used during your examination.  Place your initials to the right of the mark
to indicate your consent to the use of such device or technique.

        Tape recorder       ( )     ________________

        Video camera        ( )     ________________

        One-way mirror      ( )     ________________

        Other (specify)
        _________________   ( )     ________________

    YOUR LEGAL RIGHTS
You have the right to obtain and consult with legal counsel or an employee
representative before the examination.  You cannot be required to submit to
this examination.  Should you refuse to take the examination, such refusal
may not serve as the basis for an adverse employment action without
additional supporting evidence.  Prior to the exam, you will be provided with
a written list of intended test questions for your review and approval.  The
examiner may not ask you any question during the test that was not presented
to you in writing for review before the test.  You are permitted to terminate
the test at any time.  The examiner may not ask you questions in a manner
designed to degrade or needlessly intrude on you.  The examiner may not ask
you questions concerning religious beliefs or affiliations, political beliefs
or affiliations, beliefs or opinions regarding racial matters, any matter
relating to sexual behavior, and beliefs, affiliations, opinions or lawful
activities regarding unions or labor organizations.  You may not submit to
the polygraph examination if there is sufficient written evidence by a
physician that you are suffering from a medical or psychological condition or
undergoing treatment that might cause abnormal responses during the actual
testing phase.
    REMEDIES FOR VIOLATION
Any employer who violates any provision of the Employee Polygraph Protection
Act of 1988 may be assessed a civil penalty of not more than $10,000 by the
Secretary of Labor.  Any employer who violates this Act shall also be civilly
liable to the employee affected by such violation.  Such employer shall be
liable for such legal or equitable relief as may be appropriate, including,
but not limited to, employment, reinstatement, promotion, payment of lost
wages and benefits, and reasonable costs, including attorney's fees.  Such an
action may be maintained against the employer in any Federal or State court
of competent jurisdiction.  No such action may be commenced more than 3 years
after the date of the alleged violation.


    INSTRUCTIONS
Please return one copy of this letter prior to the exam date, signed by you
where indicated, acknowledging that you have read this document and
understand your rights under the Act.  If you are under 18 years of age, we
must first obtain the consent of your parent or guardian.  Your employer must
maintain a copy of this document for at least 3 years.


                    Sincerely,


                    _______________________________________
                    Authorized Company Representative

                    _____________________________
                    Title

                    _____________________________
                    Date



I, __________________________________________, have read the foregoing
document regarding the provisions of the Employee Polygraph Protection Act of
1988.  I hereby agree to submit to such a polygraph examination at the date,
time and place requested, and further acknowledge and agree to all the
above-listed terms, conditions, limitations and requirements. 



                    ______________________________________
                    Signature of person to be examined