Agenda Packets - 2020/05/11 - Laserfiche WebLink

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*City of Mounds View* DOT Drug -Free Workplace Policy 2020 Version 21 Acknowledgement of Receipt of Policy I hereby acknowledge that I have received, read, and understand my Company’s Drug-Free Workplace Program Policy required by Department of Transportation (DOT) regulations. I understand that I am subject to and must adhere to the DOT regulations, and must abide by the terms of the Company’s Policy as a condition of employment. I understand that during my employment I may be required to submit to drug and/or alcohol tests based on Department of Transportation regulations as directed by the Company. I agree to comply with the Company’s Policy on drugs and/or alcohol and understand failure to comply is grounds for disciplinary action, up to and including termination, in addition to any action required by DOT regulations. I also understand that refusal to submit to a controlled substances or alcohol test is a violation of DOT regulations, as well as the Company's Policy, and may result in disciplinary action, including but not limited to suspension (with or without pay) or termination of employment, in addition to action required by DOT regulations. I further understand the consequences related to controlled substances use or alcohol misuse as prohibited by Company's Policy. I acknowledge that the provisions of Company's Drug -Free Workplace Program Policy are part of the terms and conditions of my employment, and that I agree to abide by them. THE UNDERSIGNED STATES THAT HE OR SHE HAS READ THE FOREGOING ACKNOWLEDGEMENT AND UNDERSTANDS THE CONTENTS THEREOF. Employee Name: _______________________________________ Date: Employee Signature: Company Name: City of Mounds View I am the parent/guardian of_____________________________________________________, and I acknowledge that I understand the company’s Drug-Free Workplace policy. I hereby agree to his/her participation in the Company’s Drug -Free Workplace Program. Parent/Guardian Signature: Date: Parent/Guardian Printed Name: Date: NOTE: This certificate should be retained in a secured file.