File:  GBEC-E

                                                                                                                                   

 

 

 

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.

 

 

 

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Employee name (Printed)

 

 

 

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Employee signature

 

 

 

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Date

 

Issue date: September 22, 2014