Fillable Drug Free Workplace Certification - Drug_Free_Workplace_Form

Fill Online, Printable, Fillable, Blank Drug Free Workplace Certification - Drug_Free_Workplace_Form Form

Use Fill to complete blank online WEST GEORGIA COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Drug Free Workplace Certification - Drug_Free_Workplace_Form

On average this form takes 1 minutes to complete

The Drug Free Workplace Certification - Drug_Free_Workplace_Form form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 4 other fields

Country of origin: US
File type: PDF

U.S.A. forms for West Georgia College

BROWSE WEST GEORGIA COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
!
March!2016!(v.3)!
EMPLOYEE'CERTIFICATION'
'
DRUG-FREE'WORKPLAC E'
!
EMPLOYEE!NAME:!!
JOB!TITLE:!
DEPARTMENT:!!
!
I!under st an d !a n d !a c kn o wledge!th a t!the!U nive rsity!of!W es t!Geo rgia,!i n !c o mpliance !with!the!f e d e ra l! Drug-
Free!Workplace!Act!of!1988,!has!a!Drug-Free!Workplace!(“Policy”),!and!in!accordance!with!that!Policy,!
the!University:!
!
1. PROHIBITS!the!unlawful!manufacture,!distribution,!dispensation,!possession!or!use!of!a!
controlled!substance!in!the!workplace.!
!
2. SHALL!SANCTION!violations!of!this!Policy!by:!
a) Instituting!the!a p p ropriate!ac tio n (s )!u p !to!and!inc lu d in g!dismissal,!in !a cc o rd a n c e!with!
appropriate!University!disciplinary!procedures;!
! ! or!
b) Requiring!satisfactory!participation!in!an!approved!drug!abuse!assistance!or!rehabilitation!
program.!
! !
3. REQUIRES!as!a!condition!of!employment!that!I!shall:!
a) Abide!by!the!terms!of!the!Policy;!
! and!
b) Notify!my!supervisor,!in!writing,!if!I!am!convicted!of!a!violation!of!a!criminal!drug!statute!
where!the!violation!occurred!in!the!workplace,!no!later!than!five!(5)!calendar!days!after!
such!conviction.!
! !
!
I!certify!by !m y !s ign a tu r e !b elo w!that!I!ha ve !re c eiv e d !a!c o p y !o f!th e !P o lic y!S ta te ment!on !a!Drug-Free!
Workplace.!I!understand !t h a t!a!condition!of!my!employment!under!the!grant!I!am!required!to!adhere!to!
and!abide!by!this!Policy!and!will!notify!my!employer!with!in!five!(5)!days!of!any!criminal!conviction!for!a!
violation!of!the!drug!statute!occurring!in!the!work!place.!
!
I!will!ensu r e!t h a t!a ll!employee s!o n!this!fede ra l!g ra n t!(fa c u lty ,!sta ff,!a n d !student)!will!receive!a!copy!of!
the!university!Dru g-Free!Workplace!policy.!
!
!
!
SIGNATURE:________________________________!!DATE:!______________!
!
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Drug Free Workplace Certification - Drug_Free_Workplace_Form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 10 February 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document