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Polygraph Examination Waiver

This document is a waiver for a polygraph examination signed by Rigel Lopez. It states that Lopez has been requested to take a polygraph exam related to certain inquiries and has been informed of their rights regarding the exam, including the right to consult a lawyer. It specifies that Lopez provides consent to be examined, agrees to cooperate fully, and does so freely without threats or promises having been made.

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Aron Lorenzo
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279 views1 page

Polygraph Examination Waiver

This document is a waiver for a polygraph examination signed by Rigel Lopez. It states that Lopez has been requested to take a polygraph exam related to certain inquiries and has been informed of their rights regarding the exam, including the right to consult a lawyer. It specifies that Lopez provides consent to be examined, agrees to cooperate fully, and does so freely without threats or promises having been made.

Uploaded by

Aron Lorenzo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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POLYGRAPH EXAMINATION WAIVER

Place:
Date & Time:

I , Rigel Lopez, have been requested by Polygraph Examiner, Apollo Jonas


Lorenzo, of the Philippine National Police Crime Lab to submit myself to a
polygraph examination relative to my knowledge of participation in the said
inquiries.

With the respect to that request, I have been advised:


(a) That I have the right to consult with a lawyer prior to making any decision
concerning the examination;
(b) that the polygraph examination wilI be conducted only with my prior written
consent;
(c) that no adverse action wiII be taken against me solely on the grounds that
I refuse to consent to this examination;
(d) that the area in which the examination is to be conducted (does) (does
not) contain a two-way mirror or similar device;
(e) that the area in which the examination is to be conducteci (does) (does
not) contain a camera;
(f) that the area in which the examination is to be conducted (does) (does not)
contain an electronic audio recording device and the polygrapll examination
(will not) be monitored,

With an understanding of the above conditions, I have decided that I do not


dlesire to consuIt with a lawyer at this time. I freely consent to be examined by
polygraph and I agree to cooperate fully with the examiner during that
examination, I make these decisions freely and voluntarily and they are made
with no threats having been made or promises extended to me.

Signature

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