435.E1 - Drug & Alcohol Program and Pre-Employment Testing Acknowledgment Form
435.E1 - Drug & Alcohol Program and Pre-Employment Testing Acknowledgment FormSTAFF PERSONNEL
Series 400
Policy Title: Drug and Alcohol Testing Program and
Pre-Employment Testing Acknowledgment Form
Code No. 435.E1
I, , have received a copy, read and understand the Drug and Alcohol Testing Program policy of the Carroll Community School District and its supporting documents.
I understand that if I violate the Drug and Alcohol Testing Program policy, its supporting documents or the law, I may be subject to discipline up to and including termination or I may be required to successfully participate in a substance abuse evaluation and a substance abuse treatment program, if recommended by a substance abuse treatment professional. If I am required to and fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program, I understand 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.
In addition, I have received a copy of the U.S. DOT publication, “What Employees Need to Know about DOT Drug & Alcohol Testing,” and have read and understand its contents.
Furthermore, I know and understand that I am required to submit to a controlled substance (drug) test, the results of which must be received by the school district before being employed by the school district and before being allowed to perform a safety-sensitive function. I also understand that if the results of the pre- employment test are positive, that I will not be considered further for employment with the school district.
I further understand that drug and alcohol testing records and information about me are confidential, and may be released at my request or in accordance with the school district’s drug and alcohol testing program policy, its supporting documents or the law.
(Signature of Employee) (Date)
Date of Adoption/Revision
August 2013 October 2016 March 2020
435E2 Drug and Alcohol Testing Program Notice to Employees
435E2 Drug and Alcohol Testing Program Notice to EmployeesSTAFF PERSONNEL
Series 400
Policy Title: Drug and Alcohol Testing Program Notice to Employees
Code No.: 435E2
EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE HEREBY NOTIFIED they are subject to the school district's drug and alcohol testing program for pre-employment drug testing and random, reasonable suspicion and post-accident drug and alcohol testing as outlined in the Drug and Alcohol Testing Program policy, its supporting documents and the law.
Employees who operate school vehicles are subject to drug and alcohol testing if a commercial driver's license is required to operate the school vehicle and the school vehicle transports sixteen or more persons including the driver or the school vehicle weighs twenty-six thousand, one pounds or more. For purposes of the drug and alcohol testing program, "employees" also includes applicants who have been offered a position to operate a school vehicle. The employees operating a school vehicle are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate a school vehicle and continue to be subject to the drug and alcohol testing program.
It is the responsibility of the superintendent to inform employees of the drug and alcohol testing program requirements. Employees with questions regarding the drug and alcohol testing requirements will contact the school district contact person.
EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED that employees violating this policy, its supporting documents or the law may be subject to discipline up to and including termination.
EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED that information related to drug or alcohol violations will be reported to the Federal Motor Carrier Safety Administration (FMCSA) Clearinghouse.
EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED it is a condition of their continued employment to comply with the Drug and Alcohol Testing Program policy, its supporting documents and the law. It is a condition of continued employment for employees operating a school vehicle to notify their supervisor of any prescription medication they are using. Drug and alcohol testing records about a driver are confidential and are released in accordance with this policy, its supporting documents or the law.
Date of Adoption/Revision:
March 2020
435E3Drug and Alcohol Program and Pre-Employment Testing Written Consent to Share Information
435E3Drug and Alcohol Program and Pre-Employment Testing Written Consent to Share InformationSTAFF PERSONNEL
Series 400
Policy Title: Drug and Alcohol Program and Pre-Employment Testing Written Consent to Share Information
Code No.: 435E3
I, _________________________________, understand that as part of my employment in a position that requires a commercial driver’s license in the Carroll Community School District, I grant consent for the district to conduct queries of the Federal Motor Carrier Safety Administration (“FMCSA”) Commercial Driver’s License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I further consent to the district sharing information related to my drug and alcohol testing results with prior, current and future employers, as well as the FMCSA Clearinghouse in accordance with state and federal laws.
I understand that the district will check and perform queries of my drug and alcohol testing results prior to my employment in any position which requires the use of a commercial driver’s license. I further understand the district will check and perform queries of my testing results annually and is required to report any drug and alcohol violations of this policy to the FMCSA Clearinghouse.
I understand that I am not required to consent to the query of the FMCSA Clearinghouse or the district sharing of drug and alcohol testing information with past, present or future employers or the FMCSA Clearinghouse; but that without my consent I understand I will be prohibited from performing safety sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
I hereby give my consent to the district to perform queries of the FMCSA Clearinghouse and share my drug and alcohol testing results with past, present and future employers, as well as the FMCSA Clearinghouse.
__________________________________________________
(Signature of Employee) (Date)
Date of Adoption/Revision:
March 2020