403.7E2 - Drug and Alcohol Testing Program Acknowledgement Form

I,  ___________________________________  (Name of Employee),  have received a copy, read, and understand the drug and alcohol testing program policy and its supporting documents.  I consent to submit to the drug and alcohol testing program as required by the drug and alcohol testing program policy, its supporting documents, and the law.

I understand that if I violate the drug and alcohol testing program policy, its supporting documents or the law, I may be subject to discipline up to and including termination or I may be required to successfully participate in a substance abuse evaluation and a substance abuse treatment program, if recommended by the substance abuse professional.  If I am required to and fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program, I understand I may be subject to discipline up to and including termination.

Furthermore, I know and understand that I am required to submit to a controlled substance test, the results of which must be received by this employer before being employed by the school district and before being allowed to perform a safety-sensitive function.  I also understand that if the results of the pre-employment test are positive, that I will not be considered further for employment with the school district.

I also understand that I must inform my supervisor of any prescription medication I use.  I further understand that drug and alcohol testing records about me are confidential and may be released in accordance with this policy, its supporting documents or the law.

 

 

______________________________________________                ______________________
Signature of Employee                                                                                              Date