Employee Acknowledgment Form
Alcohol and Drug-Free Workplace
South Conejos School District
I, THE UNDERSIGNED EMPLOYEE OF ____________________________, have received a copy of the Alcohol and Drug-Free Workplace policy and:
1. I agree to abide by the terms of the policy.
2. I agree to notify my supervisor if I am convicted of violating a criminal drug statute in the workplace no later than five days after the date of such conviction.
Employee name (Printed)
Issue date: September 22, 2014