EMPLOYEE NOTICE AND ACKNOWLEDGEMENT OF EMPLOYER TESTING REQUIREMENTS

PART 1: NOTICE

This is to inform you that the company/organization conducts testing to identify job applicants and current employees who may be abusing drugs and/or alcohol.

A copy of the company's/organization's policy on this matter is either attached to this notice or will be given to you upon request.

You have the right to refuse to undergo testing. However, the consequences of refusal to undergo testing or a refusal to cooperate in testing by an applicant will result in the termination of the pre-employment selection process, and the consequences of refusal to undergo testing or a refusal to cooperate in the testing by an employee will result in disciplinary action up to and including discharge.

An applicant who fails a test will not be hired, and an employee who fails a test will be subject to disciplinary action up to and including discharge.

Remaining drug-and/or alcohol-free and participation in the company's/organization's drug and/or alcohol testing program is a condition of continued employment.

PART II: ACKNOWLEDGEMENT

I acknowledge receipt and understanding of the above written notice and agree to abide by the terms of the company's/organization's policy pertaining to drugs and alcohol.

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(Signature)                                     (Date signed)

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(Printed name                                   (Signature of witness)

NOTE: This form should be customized with your company or organization's name and should reference only drugs or alcohol, or both, depending upon which options you select for testing requirements.