403.6E2 DRUG AND ALCOHOL TESTING PROGRAM ACKNOWLEDGMENT FORM
Code No. 403.9E2
Drug and Alcohol Testing Program Acknowledgment Form
I, ____________________, 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, regulations and the law.
I understand that if I violate the Drug and Alcohol Testing Program policy, its supporting documents, regulations or the law, 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. 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, regulations or the law.
_____________________________ ___________________
Signature of Employee Date
MORNING SUN COMMUNITY SCHOOL DISTRICT BOARD OF DIRECTORS