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.
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Signature of Employee
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Printed Name of Employee
Approved: 03/15/2021 Reviewed: 02/15/2021 Revised: 02/15/2021
