2010 General Compliance Training

Certification Form
Employee Demographics To be completed by the employee only. For purposes of this certification form, the term
"employee" includes temporary employees and independent contractors.
Last Name MI First Name

Employee Number (5 or 6 digits) Date New Hire?

Yes No

Business Address

City State ZIP Code

Business Telephone Number Extension Division

Circle one of the following which best describes the manner in which you received this training.
Live presentation Narrated slide show Video Other (specify)

Employee Acknowledgment

I, acknowledge that I have received general compliance

training. I am aware that as a condition of my employment with LabCorp, I must strictly comply with:

All Standards of Conduct as set forth in the LabCorp Business Practices Compliance Policy, the LabCorp Code of
Business Practices, and any other manuals, handbooks, brochures, and materials maintained by LabCorp;

The LabCorp Corporate Integrity Program; and

All applicable laws, policies, and procedures as set forth in the training presentation.

I realize that LabCorp will take appropriate disciplinary action, up to and including termination of my employment,
for violating any of the principles or practices set forth in the Standards of Conduct, the Corporate Integrity
Program, or the applicable laws.

Signature Date
Give completed copy to your Supervisor
© 2010 Laboratory Corporation of America® Holdings