403.7E2 - Certification from Current Employer Participating in Drug & Alcohol Program

I, ______________________________________________________________ am currently employed by
                                               Name of Undersigned

 __________________________________________________________ who participates in the Drug and Alcohol
                                          Employer   

Program through ____________________________________________.  I consent to have my records pertaining                                                                                                              
                                       Drug & Alcohol Testing Provider

to drug and alcohol testing released to the Independence Community School District for the past 24 months of

employment.

_______________________________________________         _______________
(Signature)                                                                                                            (Date)

_______________________________________________         _______________
(Signature of Employer)                                                                                   (Date)