I, ( ______________________________________________________ ), have received a copy, read and
Name of Employee
understand the Drug and Alcohol Testing Program policy and its supporting documents. I have also read and
understand the “Drug and Alcohol Training Handbook” provided to me by the district. 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 when requested. 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)
_______________________________________________ _____________________________
(Witness/Transportation Director) (Date)
