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Polygraph examination consent

Form 2801 examination statement-2026

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The document is a Polygraph Examination Statement of Consent used by the United States Army. It outlines the rights of the examinee, including the right to refuse the examination without adverse consequences, the right to consult with a lawyer, and details about the examination process. The examinee voluntarily consents to undergo the polygraph examination, acknowledging that they can withdraw consent at any time.

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Click ‘Get Form’ to open the form 2801 examination statement in the editor.
Begin by filling in your FILE NUMBER, LOCATION, and TIME at the top of the form. Ensure these details are accurate as they are essential for identification.
Next, enter your NAME (Last, First, MI), GRADE/STATUS, and ORGANIZATION OR ADDRESS. This information helps establish your identity and context for the examination.
In the STATEMENT OF CONSENT section, read through each point carefully. You may need to provide additional context or acknowledgment regarding your rights and understanding of the polygraph process.
Sign and date where indicated as the EXAMINEE. Ensure that you do this in front of witnesses who will also need to sign the document.
Finally, have the EXAMINER complete their section by signing and providing their typed name and organization/address.

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Versions	Form popularity	Fillable & printable
2011	4.8 Satisfied (190 Votes)
1985	4 Satisfied (51 Votes)

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Form 2801 examination statement-2026

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