403.6E2 - Drug and Alcohol Testing Program Acknowledgment Form

COLO-NESC O COMMUNITY SCHOOL DISTRICT
DRUG AND ALCOHOL TESTING PROGRAM
ACKNOWLEDGEMENT FORM

I, ________________________________, have received a copy, read and understand the Drug and Alcohol Testing Program policy of the Colo-NESCO Community School District and its supporting documents.

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 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.

I also understand that I must inform my supervisor of any prescription medication I use.

In addition, I have received a copy of the U.S. DOT publication, “What Employees Need to Know about DOT Drug & Alcohol Testing,” and have read and understand its contents.

Furthermore, I know and understand that I am required to submit to a controlled substance (drug) 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 further understand that drug and alcohol testing records about me are confidential and may be released in accordance with this policy, its supporting administration regulations or the law.

 

___________________________________       
Signature of Employee 

_________________________________
Printed Name of Employee

 

 Approved: 03/15/2021                        Reviewed: 02/15/2021                       Revised: 02/15/2021