Controlled Substance Testing Policy Policy Revised: Effective
|
|
- Ashlynn Marion Brown
- 5 years ago
- Views:
Transcription
1 Controlled Substance Testing NOTE: This is a sample. It is intended to assist providers with drafting a policy and procedure for their operations. This template includes a number of blanks and requires the Agency to carefully consider its plans. Purpose Because ("the Agency") is a licensed home health agency in Indiana, it is required, as a term of its license to operate as a home health agency, to implement a program to test job applicants and certain employees for the illegal use of controlled substances. Furthermore, because the Agency provides services to patients who may be frail and unable to care for their own needs and provides these services under programs regulated by state and federal laws, the Agency has a compelling obligation to eliminate substance abuse from its workforce. The illegal use of Controlled Substances by employees adversely impacts an employee s job performance, as well as endangers other employees, our patients and the general public. It is therefore necessary that the Agency maintain a work environment that is free from the effects of the illegal use of controlled substances by unlicensed employees who will have direct patient contact. Definitions Covered Applicant. As used in this and Procedure, the term "Covered Applicant" means an individual who is not licensed by a Board or Commission under Title 25 of the Indiana Code and who is applying for a position which will require the applicant to have direct patient contact. Covered Employee. As used in this and Procedure, the term "Covered Employee" means an employee who will have direct patient contact and who is not licensed by a Board or Commission under Title 25 of the Indiana Code. Randomly Selected Covered Employees. As used in this and Procedure, the term "Randomly Selected Covered Employees" means the Covered Employees who are selected at Random to undergo a Test for Controlled Substances. Test for Controlled Substances. As used in this and Procedure, the term "Test for Controlled Substances" means a test that utilizes a [blood/urine] specimen in a five panel test that test the specimen for the presence of amphetamines, cocaine, marijuana, opiates and PCP. [COMMENT: This is the minimum testing. An agency may choose to implement a broader testing panel, including alcohol testing. Most agencies will utilize urine sample testing, although testing companies may offer options that include blood tests and hair sample testing. Urine sample tests tend to be the most cost effective.]
2 TESTING PROCEDURES AND METHODS Controlled Substance Testing A Covered Employee or an Applicant who is required to undergo a Test for Controlled Substances will provide a [blood/urine] sample as outlined in the Agency's sample collection procedures. The Covered Employee or Applicant who is the subject of a Test for Controlled Substances will be provided with a written report of the test results and any follow-up confirmation tests. [COMMENT: This will be driven by the agency's vendor. This will need to include a consent to sharing the results with the Agency and, if there are related providers, for the Agency to share with those other entities.] CONTROLLED SUBSTANCE TESTING APPLICANTS All Covered Applicants will be provided a copy of this and required to sign an acknowledgement that the Covered Applicant received a copy of this. Covered Applicants will also sign a consent form provided by the testing company authorizing disclosure of the test results to the Agency. Upon completion of all other aspects of the hiring process, if a decision to hire a Covered Applicant is made, the Covered Applicant will be offered employment conditioned upon taking and passing a Test for Controlled Substances. Refusing Test Applicants A Covered Applicant's refusal to submit to a Test for Controlled Substances will be treated as if the Covered Applicant had taken the Test for Controlled Substances and obtained a positive test. This will result in the Applicant's conditional employment being terminated due to failure to take and pass a Test for Controlled Substances. Result of Test - Applicants If the Test for Controlled Substances results in a positive test, the Covered Applicant will be given forty eight (48) hours to produce a valid, current, subscription for the controlled substance for which the Applicant tested positive. If the Covered Applicant cannot produce a valid, current, subscription, the Covered Applicant's conditional employment will be terminated due to failure to take and pass a Test for Controlled Substances. A copy of the, Acknowledgement and Consent will be maintained with the rest of the Applicant's application materials. The Applicant's test results will be maintained in a separate confidential file with the other applicants' test results. If the Test for Controlled Substances results in a negative test, the Covered Applicant will be immediately available to be scheduled to work. The Covered Applicant will be added to the roster of Covered Employees. The individual's application materials, including the,
3 Controlled Substance Testing Acknowledgement and Consent will be placed in the individual's personnel file. The test results will be placed in the confidential portion of the individual's personnel file. [OPTIONAL: Hiring Covered Applicant Pending Results of Test for Controlled Substances [COMMENT: This is optional. It is recommended that Covered Applicants not be hired if they test positive.] A Covered Applicant may be hired pending the results of the Test for Controlled Substances, but may not have direct patient contact until the Agency has received proof that the result of the Test for Controlled Substances was negative. If the Test for Controlled Substances results in a positive test for a Covered Applicant who was allowed to begin working before the results were received, the Agency will [immediately terminate the individual's employment/prohibit the individual from having direct patient contact for six months]. COMMENT: It is recommended that a positive test result lead to immediate termination. If the individual is suspended for six months, reinstatement should be dependent upon substance abuse counseling and passing a return to duty.] CONTROLLED SUBSTANCE TESTING COVERED EMPLOYEES The organization s Covered Employees are required to undergo a Test for Controlled Substances under the following circumstances: 1. Random Testing: On or before June 30 of each year, the Agency will subject the Randomly Selected Covered Employees to a Test for Controlled Substances. 2. Reasonable Suspicion testing: A Covered Employee shall be required to undergo a Test for Controlled Substances at any time the Agency has reasonable suspicion that a Covered Employee is engaged in the illegal use of a controlled substance.. "Reasonable Suspicion" may exist based on, among other things: a. Direct observation of drug or alcohol use or possession; b. Observation of physical conditions which indicate symptoms of being under the influence of drug or alcohol, including but not limited to: i. Odor; ii. Gait; iii. Speech; iv. Appearance; v. Statements; vi. Evidence of use (for example, syringe or vile); vii. Response to questions.
4 Controlled Substance Testing c. A pattern of abnormal conduct or erratic behavior (including but not limited to absenteeism, tardiness, or deterioration in work performance); d. Arrest or conviction for a drug-related offense, or being identified as the focus of a criminal investigation into illegal drug possession, use, or trafficking; e. A news report of a drug related arrest; f. Information provided either by reliable and credible sources or that is independently corroborated; or g. Newly discovered evidence that the employee has tampered with a previous drug/alcohol test. 3. Post-accident testing: the Agency shall require a Covered Employee to undergo a Test for Controlled Substances if the Covered Employee is involved in an accident or incident while on the clock (i) which results in the Covered Employee or another person sustaining an injury, or (ii) which results in damage to the Agency s property, the Covered Employee's property and/or the patient's property, including damage to equipment. 4. Post-rehabilitation/return to work testing: The Agency shall require an individual who was on a temporary leave of absence, FMLA or similar time off to undergo counseling for drug abuse to undergo a Test for Controlled Substances before returning to work. [COMMENT: The statute only requires (a) and (b). Post-accident testing is quite common, due to insurance issues and could be considered similar to reasonable suspicion testing. Post rehabilitation testing would only be needed if the employer were to invoke suspensions for employees who tested positive.] Random Testing Procedure Identifying the Sample Beginning on July 1, 2017 and annually thereafter, the Agency will determine the number of Covered Employees on its employee roster. The Agency will then multiple this number by 50% to identify the number of Covered Employees the Agency must randomly test before June 30 of the following year (the "Number of Required Tests"). Once the Number of Required Tests is determined, the Agency will randomly select that number of individuals from the list of all Covered Employees. These individuals will be identified on July 1, but need not be tested immediately. The Agency must complete the Number of Required Tests on or before June 30 of the next year.
5 Controlled Substance Testing In the event a Covered Employee who is selected for testing is no longer employed at the time the test is to be performed, another Covered Employee will be selected from the list compiled on the immediately preceding July 1 at random. If, due to employee turnover, there are not enough Covered Employees on the July 1 list to perform the Number of Required Tests, Covered Employees will be randomly selected from the population of Covered Employees at the time the test is to be performed until the Number of Required Tests has been performed, even if this requires the Agency to test newly hired employees who tested during the application process. When determining if the Number of Required Tests has been performed, the Agency shall include the number of tests based upon Reasonable Suspicion it has performed during the year. Refusing Required Test A Covered Employee's refusal to submit to a Test for Controlled Substances will be treated the same as a positive test. It will result in [immediate termination of employment/suspension from employment for at least six months].comment: The statute allows the employer to either terminate or suspend for a refusal. It does not give the option to simply suspend from direct patient contact. This is different than the required response to a positive test. It is recommended that a refusal or a positive test both result in termination.] Covered Employee - Positive Results If a Test for Controlled Substances performed on a Covered Employee is positive, the Covered Employee shall be informed of the result. 1. Prescription. The Covered Employee shall be provided forty eight (48) hours to produce a valid, current, prescription for the Controlled Substance for which the individual tested positive. If the individual is able to produce a valid prescription, a copy of the prescription shall be maintained in the individual's personnel file and no action shall be taken against the individual. 2. Verification. If the Covered Employee cannot produce a valid prescription, the Agency shall have the results of the Test for Controlled Substances verified by having the test confirmed through a retesting of the sample by the testing entity (the "Verification Test"). The Covered Employee shall be responsible for the charges for the Verification Test and will receive an invoice for the cost of the Verification Test. If the Verification Test confirms the original positive test the Covered Employee will be [terminated/suspended from direct contact with patients for at least six months].[ [COMMENT: Termination for a positive test is recommended. If an employer chooses to suspend the employee, a return to work test is recommended. Suggested Language A Covered Employee who is suspended for failing a required Test for Controlled Substances will be required to take and pass a Test for Controlled Substances prior to returning from suspension.] A copy of the results of the Test for Controlled Substances shall be placed in the confidential section of the Employee's Personnel File. A copy of the written [termination/suspension]
6 Controlled Substance Testing including a statement that the [termination/suspension] is due to a failed Test for Controlled Substances. Negative Result of Test for Controlled Substance If the Test for Controlled Substances returns a negative result, a copy of the test result shall be placed in the confidential portion of the Employee's Personnel File. Voluntary Reporting It is the Agency s intent to assist its employees who have substance abuse problems. An employee who voluntarily reports a substance abuse problem to the Administrator will be directed to EAP for coordinating a chemical dependency evaluation, rehabilitation, and followup. If a leave of absence is necessary, the employee will be considered for all eligible leaves of absence allowed pursuant to Agency policy. However, this voluntary reporting provision will not prevent the Agency from otherwise enforcing this policy and/or disciplining the employee for violations of this or other Agency policies. Drug Testing Records - Confidentiality Records of all Tests for Controlled Substances, including results, Covered Employee prescription information and related information maintained by the Agency (the "Drug Testing Records") shall be the property of the Agency. These Drug Testing Records are subject to confidentiality requirements and the Agency will maintain confidentiality. The Agency shall keep each Covered Employee's Drug Testing Records in the confidential medical record portion of the Covered Employee's Personnel File. [COMMENT: Providers may consider having a centralized master testing file for survey purposes. This would include copies of the relevant records and test results. It would be kept confidential and secured.] Drug Testing Records Release by Organization Upon the written request of the applicant or Covered Employee tested, results of a Test for Controlled Substances shall be made available for inspection and copying to the applicant or Covered Employee. The Agency shall not release such records to any person other than the applicant or Covered Employee unless the applicant or Covered Employee, in writing following receipt of the test results, has expressly granted permission for the Agency to release such records The organization may release records of all drug and alcohol test results and related information maintained by the Agency for the following reasons:
7 Controlled Substance Testing 1. The records are evidence that may be admissible in a proceeding before a court or an administrative agency in which either the Agency or the Covered Employee whose test results are being admitted is a named party to the lawsuit; or, 2. In order to comply with a valid judicial or administrative order.
8 Controlled Substance Testing SAMPLE: DRUG SCREENING AGREEMENT Pre-employment Screening I have been informed that it is the policy of the Agency to perform pre-employment testing for the illegal use of drugs. The drug test will be performed by [insert name of vendor]. I have been informed, and I understand, that my consent to submit to the pre-employment drug testing is completely voluntary on my part, and that I have the right to refuse to submit to the test. I am aware, and have been told, that my refusal to submit to the drug test will make me ineligible for employment with the Agency. I have also been informed and am aware and hereby authorize that the results of the drug test may be released to the Agency [and name related entities if applicable]. I understand that the information will be used to determine whether I am eligible for employment with the Agency. With full knowledge of the above information, I have decided to voluntarily submit to the requested drug test by the Agency and in recognition of this agreement, to sign this consent form. Date Date Employee Signature Witness REFUSAL TO SUBMIT TO DRUG SCREEN I hereby refuse to authorize testing for the illegal use of drugs. I understand that my refusal means that I am ineligible for employment with the Agency. Signature Date Witness Date v1
Biscuitville SUBSTANCE ABUSE POLICY
Biscuitville SUBSTANCE ABUSE POLICY I. PURPOSE As a part of its commitment to safeguard the health of its employees, to provide a safe place for its employees to work and to promote a drug-free community,
More informationCorporate Policy and Pocedure
Corporate Policy and Pocedure Policy # Revision # Effective Date: July 23, 2015 Prepared by: Workforce Compliance Approved by: Compliance Committee Title: Southern Company Gas Drug and Alcohol Policy Purpose:
More informationSUBSTANCE ABUSE POLICY
SUBSTANCE ABUSE POLICY The Company has a vital interest in the health and welfare of its employees. The misuse and abuse of alcohol and drugs by employees pose serious threats to the safety and health
More informationDRUG AND ALCOHOL ABUSE POLICY
Disclaimer: This Drug and Alcohol Policy is provided as an example for your consideration, before making any changes please consult your legal team for advice. PURPOSE The Company continues its commitment
More informationCORPORATE POLICY SUBSTANCE ABUSE POLICY SCOPE
ORIGINAL EFFECTIVE: REVISION NO. REVISION EFFECTIVE: CORPORATE POLICY POLICY NO. PAGE NO. 1 SUBSTANCE ABUSE POLICY SCOPE This policy applies to all* regular status full-time and part-time employees of
More informationREDI MART TOBACCO Drug-Free Workplace Policy
REDI MART TOBACCO Drug-Free Workplace Policy Redi Mart Tobacco (referred to as The Company) is firmly committed to providing a drug-free workplace for the safety of its employees and for the safety of
More informationELECTRICAL INDUSTRY UNIFORM DRUG/ALCOHOL TESTING PROGRAM I.B.E.W. LOCAL 110 HIGHLIGHTS OF THE ELECTRICAL INDUSTRY DRUG/ALCOHOL TESTING PROGRAM PURPOSE
ELECTRICAL INDUSTRY UNIFORM DRUG/ALCOHOL TESTING PROGRAM 2018 I.B.E.W. LOCAL 110 HIGHLIGHTS OF THE ELECTRICAL INDUSTRY DRUG/ALCOHOL TESTING PROGRAM PURPOSE Purpose of the program is to increase work place
More informationAny fraudulent information provided on this application will be cause for rescinding any and all WC benefits.
This package contains the following documents: Employment Application Accidents and Injuries Procedures Substance Abuse Policy Drug and/or Alcohol Testing Consent Form Form I-9 Form W-4 Completion of this
More informationPRELIMINARY QUESTIONNAIRE FOR EMPLOYMENT CONSIDERATION
SOUTHERN LUMBER AND MILLWORK CORPORATION 2031 KING STREET P.O BOX 20039 CHARLESTON, SC 29413-0039 (843) 744 6281 PRELIMINARY QUESTIONNAIRE FOR EMPLOYMENT CONSIDERATION Please Print and Sign Name Address
More informationCITY OF CRIPPLE CREEK DRUG AND ALCOHOL TESTING POLICY AND PROCEDURE MANUAL
CITY OF CRIPPLE CREEK DRUG AND ALCOHOL TESTING POLICY AND PROCEDURE MANUAL I. Purpose The City of Cripple Creek is committed to a safe, healthy, and productive work environment for all employees free from
More informationUPMC POLICY AND PROCEDURE MANUAL
SUBJECT: Fitness for Duty DATE: November 8, 2013 I. PURPOSE/SCOPE UPMC POLICY AND PROCEDURE MANUAL POLICY: HS-HR0721 * INDEX TITLE: Human Resources This policy applies to all United States based UPMC staff
More informationDRUG FREE WORKPLACE POLICY
DRUG FREE WORKPLACE POLICY PURPOSE: The Early Learning Coalition of Pasco and Hernando Counties, Inc. (ELCPH), is committed to providing a safe work environment and to fostering the well-being and health
More informationDuplin County Alcohol and Drug-free Workplace Policy Adopted
Duplin County Alcohol and Drug-free Workplace Policy Adopted 9-21-09 Purpose and Goal Duplin County is committed to protecting the safety, health and well being of all employees and other individuals in
More informationT O W N O F H O O K S E T T PERSONNEL PLAN
T O W N O F H O O K S E T T PERSONNEL PLAN This document supersedes all personnel policies previously established or approved by the Town Council. Approved - February 17, 2010 Latest revision January 24,
More informationCHAPTER: 06 - Human Resources Policies
CHAPTER: 06 - Human Resources Policies SECTION: 01 - Standard of Conduct SUBJECT: 01 - Drug Free Workplace POLICY #: 06.01.01 DEPARTMENT: Human Resources EFFECTIVE DATE: October 1, 2015 CITY MANAGER: Erdal
More informationDRUG AND ALCOHOL-FREE WORKPLACE POLICY
DRUG AND ALCOHOL-FREE WORKPLACE POLICY Mister Car Wash (MCW) is committed to protecting the safety, health and well-being of all employees and other individuals in our workplace. Drug and alcohol use pose
More informationDRUG-FREE WORKPLACE AND DRUG TESTING
01/01/2018: Pen & Ink to update language to include USDOT required testing for four semi-synthetic opioids. Approved: Effective: August 16, 2017 Review: January 10, 2017 Office: Human Resources Topic No.:
More informationOverview. Today s webinar will address:
Overview Today s webinar will address: Benefits and potential risks associated with drug testing ; When and how local governments can utilize drug testing; and Practical advice on the methods of drug testing.
More informationSAINT LOUIS UNIVERSITY
SAINT LOUIS UNIVERSITY SUBSTANCE ABUSE AND TESTING POLICY Procedure Number: Version Number: 3 Classification: Effective Date: 8/29/2011 Responsible University Office: 1.0 INTRODUCTION Substance abuse is
More informationTopic 690 Page 1 of 8 ALCOHOL/SUBSTANCE ABUSE Reviewed 02/01/2012
Page 1 of 8 Policy It is the policy of Southern Research to maintain a Drug Free Workplace and Drug Free Work Force in compliance with the Federal Government Drug-Free Workplace Act of 1988. This policy
More informationHuman Resources. Drug and Alcohol Screening Procedure
Purpose Drug and alcohol abuse is a serious problem which causes grief for afflicted employees and significant costs to Salt Lake City Corporation. Our goal is to maintain a drug-free workplace in order
More informationDRUG DETECTION AND DETERRENCE POLICY
+ DRUG DETECTION AND DETERRENCE POLICY PURPOSE The purpose of this policy is to: Set standards for the implementation of Drug Testing programs in employment; Ensure that Drug Test procedures are implemented
More informationGREEN COUNTY APPLICATION FOR EMPLOYMENT
GREEN COUNTY APPLICATION FOR EMPLOYMENT GREEN COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age,
More informationPOLICIES ACKNOWLEDGEMENT
POLICIES ACKNOWLEDGEMENT DRUG AND ALCOHOL TESTING POLICY PAYCHECK AND TIME CARD POLICY SEXUAL HARASSMENT POLICY By signing this form, I confirm that I have read and understand the Drug and Alcohol Testing
More informationEmployment Testing and Background Checks Sample Policies and Forms
Employment Testing and Background Checks Sample Policies and Forms This packet is one of the many MTA resources available from the MTA Member Information Services Department at: Michigan Townships Association
More informationDrug Free Workplace and Workforce
Policy Directory Responsible Division: Finance and Administrative Services Responsible Office: Human Resources Issue/Revision Date: 12/01/2017 Drug Free Workplace and Workforce Policy: Alcorn State University
More informationDrug and Alcohol Testing Policy: Minnesota Standards. This policy was revised and approved by the Administrative Team of MSS
Drug and Alcohol Testing Policy: Minnesota Standards This policy was revised and approved by the Administrative Team of MSS DECEMBER 2016 Page 2 of 17 Index Topic Page I. Purpose 4 II. Scope 4 III. Dissemination
More informationWINNEBAGO COUNTY I. POLICY. Description: DRUG AND ALCOHOL TESTING Policy Number: 62.18
Page 1 of 6 I. POLICY It is the policy of Winnebago County for its employees to report for work and to perform services without being adversely affected or impaired by the influence of drugs and/or alcohol
More informationDrug Testing In The Workplace
Drug Testing In The Workplace Drug Testing In The Workplace Under Texas and federal laws, there is almost no limitation at all on the right of private employers to adopt drug and alcohol testing policies
More informationAPPLICATION FOR EMPLOYMENT
2000 Territory Drive, Galena, IL 61036 815-777-2000 APPLICATION FOR EMPLOYMENT The Galena Territory Association, Inc. is an equal opportunity employer and does not discriminate on the basis of race, religion,
More informationPolicy. Page 1 of 8. Applies To: UNMH Responsible Department: Human Resources Revised: 3/2017
Applies To: UNMH Responsible Department: Human Resources Revised: 3/2017 Policy Patient Age Group: (X) N/A ( ) All Ages ( ) Newborns ( ) Pediatric ( ) Adult 1. POLICY STATEMENT It is the policy of University
More information(Medicare Advantage) Magellan Healthcare Provider Group(G) Alpha Care of New York(L) Magellan Method (D)
Policy and Standards Product Applicability: (For Health Insurance Marketplaces, policies and procedures are the same, unless contractual requirements dictate a more stringent variation in which case customized
More informationPERFORMANCE FABRICATING EMPLOYMENT APPLICATION
PERFORMANCE FABRICATING EMPLOYMENT APPLICATION I. Personal Information First Name: Last Name: Street Address: City: State: Zip Code: Home Phone: ( ) Cell Phone: ( ) Social Security Number or Driver s License
More informationApplication for Employment PERSONAL INFORMATION. Social Security Number: - - Home Telephone Number: Phone:
Application for Employment North Georgia Medical Transport considers applications for employment without regard to race, color, national origin, ancestry, religion, sex, age, disability, political belief,
More informationDOC TYPE: Policy SME: Bess Evans
SUBJECT MATTER AREA: Human Resources & Labor Relations WRITER: Rachel Gray Page 1 of 20 DOC TYPE: Policy SME: Bess Evans EFFECTIVE DATE: 2/06/12 APPROVED BY: Bess Evans (Signature on File) DATE: 2/06/12
More informationWE WORK FREE. FCCI Insurance Company s Drug-Free Workplace Program
WE WORK FREE FCCI Insurance Company s Drug-Free Workplace Program Substance abuse is a real concern for businesses. By establishing a certified drug-free workplace, you have taken positive action against
More informationWashington County EMS Employment Application
Washington County EMS Employment Application Washington County EMS considers applications for employment without regard to race, color, national origin, ancestry, religion, sex, age, disability, political
More informationATTACHMENTS TO DRUG AND ALCOHOL TESTING POLICY
ATTACHMENTS TO DRU AND ALCOHOL TESTIN POLICY Attachments A through C are to be used in conjunction with the drug and alcohol testing of bus drivers and driver applicants. Attachment A is a Driver Acknowledgment
More informationApplication Disclosure Statement
Application Disclosure Statement I hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will be the
More informationZ'S BEES EMPLOYMENT APPLICATION
Z'S BEES EMPLOYMENT APPLICATION I. Personal Information First Name: Last Name: Street Address: City: State: Zip Code: Home Phone: ( ) Cell Phone: ( ) D.O.B Social Security Number And Driver s License Number:
More informationCOUNTY OF SUMMIT. Substance Abuse Policy
COUNTY OF SUMMIT Substance Abuse Policy January 1, 2015 COUNTY OF SUMMIT SUBSTANCE ABUSE POLICY: It is the policy of the County of Summit Human Resource Department (HRD) to comply with Section 169.28 of
More informationDRUG FREE WORKPLACE. Objective: To provide a safe and healthful environment for patients and employees.
Objective: To provide a safe and healthful environment for patients and employees. Policy: UHS policy prohibits the unlawful use, manufacture, possession, distribution or dispensing of drugs ("controlled
More informationEmployment Application
GENERAL INFORMATION Last Name First Name Middle Initial Street Address & Apt # City State Zip Cell Phone (With area code) Other Phone (With area code) Home Work Have you previously used names other than
More informationST. LOUIS KANSAS CITY CARPENTERS REGIONAL COUNCIL DRUG AND ALCOHOL TESTING PROGRAM POLICY
ST. LOUIS KANSAS CITY CARPENTERS REGIONAL COUNCIL DRUG AND ALCOHOL TESTING PROGRAM POLICY Drug & Alcohol Testing Policy as of 20170501 St. Louis Kansas City Carpenters Regional Council DRUG AND ALCOHOL
More informationRussell's Western Wear, Inc. Employment Application
Russell's Western Wear, Inc. Employment Application PLEASE PRINT Store Dover Lakeland Ocala Tampa Wesley Chapel Bradenton Position Applied For: Desired Salary APPLICANT INFORMATION Last Name: First Name
More informationMEYER EYECARE, INC. EMPLOYMENT APPLICATION
MEYER EYECARE, INC. EMPLOYMENT APPLICATION I. Personal Information First Name: Last Name: Street Address: City: State: Zip Code: Home Phone: ( ) Cell Phone: ( ) Social Security Number or Driver s License
More informationPosition(s) applied for Date of Application. Name Social Security Number Last First Middle
Saguache County Application for Employment Please Print Legibly Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the
More informationEXAMPLE OF A RELEASE OF INFORMATION FORM
EXAMPLE OF A RELEASE OF INFORMATION FORM Section I. To be completed by the new employer, signed by the employee and transmitted to the previous employer. Employee Printed Name: Employee SS or ID Number:
More informationAPPLICATION FOR EMPLOYMENT
ROCKLAND PARAMEDIC SERVICES, INC ROCKLAND MOBILE CARE, INC. 540 Chestnut Ridge Road Chestnut Ridge, NY 10977 APPLICATION FOR EMPLOYMENT Rockland Paramedic Services, Inc. and Rockland Mobile Care, Inc.
More informationAPPROVED: Those who regularly come in contact with youth;
GEORGIA DEPARTMENT OF JUVENILE JUSTICE Applicability: {x} All DJJ Staff { } Administration { } Community Services { } Secure Facilities (RYDC s and YDC s) Transmittal # 17-14 Chapter 3: PERSONNEL Effective
More informationAppendix F Fitness for Duty Program
BLACKWATER GOLD PROJECT APPLICATION FOR AN ENVIRONMENTAL ASSESSMENT CERTIFICATE / ENVIRONMENTAL IMPACT STATEMENT ASSESSMENT PROCESS Appendix 12.2.1F Fitness for Duty Program Section 12 FITNESS FOR DUTY
More informationABSOLUTE LASER WELDING SERVICES, LLC EMPLOYMENT APPLICATION
ABSOLUTE LASER WELDING SERVICES, LLC EMPLOYMENT APPLICATION I. Personal Information First Name: Last Name: Street Address: City: State: Zip Code: Home Phone: ( ) Cell Phone: ( ) Social Security Number
More information3 14. Drug Abuse and Controlled Substances
3 14. Drug Abuse and Controlled Substances Vectrus will not tolerate illegal drugs, controlled substances or alcohol abuse and will take all reasonable steps to ensure that drug and alcohol abuse does
More informationApplication for Employment
744 Skyline Blvd Avenal, CA 93204 312 W 7 th St Hanford, CA 93230 200 Follett St Lemoore, CA 93245 Application for Employment Last Name, First Name, Middle Initial FAST FEDERAL CREDIT UNION Application
More informationOffice of Human Resources Standard Operating Procedure HR SOP #201. Subject: Drug Testing Program
Subject: Office of Human Resources Standard Operating Procedure HR SOP #201 Drug Testing Program Effective Date: May 1, 2016 Policy Statement: The Department of Natural Resources (DNR) will administer
More informationEmployment Application
An Equal Opportunity Employer Mission Statement To provide high quality affordable housing To maintain high level of ethics and integrity To be effectively and efficiently responsive to the needs of our
More informationPediatric Associates Employment Application
Pediatric Associates Employment Application Today's Date: Name: _ Last First Middle Address: _ Street City State Zip Telephone: Home Cell/Other Email: ARE YOU LEGALLY AUTHORIZED TO WORK IN THE US? Yes:
More informationTHE CITADEL The Military College of South Carolina 171 Moultrie Street Charleston, SC MEMORANDUM 18 August 2009 NUMBER 2-109
THE CITADEL The Military College of South Carolina 171 Moultrie Street Charleston, SC 29409. MEMORANDUM 18 August 2009 NUMBER 2-109 I. Purpose Progressive Discipline Policy Employees are expected to conduct
More informationPOLICY 409 DRUG TESTING POLICY REVISED: 6/97 CFA STANDARDS: REVIEWED: 08/01, 10/07, 08/11
POLICY 409 DRUG TESTING POLICY REVISED: 6/97 RELATED POLICIES: CFA STANDARDS: 27.03 REVIEWED: 08/01, 10/07, 08/11 A. PURPOSE: The Fort Lauderdale Police Department has the responsibility to provide the
More informationWASHINGTON CONSTRUCTION INDUSTRY SUBSTANCE ABUSE PROGRAM (WCISAP) EMPLOYER MANUAL
WASHINGTON CONSTRUCTION INDUSTRY SUBSTANCE ABUSE PROGRAM (WCISAP) EMPLOYER MANUAL Revised May 2013 TABLE OF CONTENTS Tab 1 Test Authorization and Fax Form: (Authorization form used for Pre-Program, Post-Accident
More informationTHE ARKANSAS MEDICAL MARIJUANA AMENDMENT & ACT 539 OF 2017
THE ARKANSAS MEDICAL MARIJUANA AMENDMENT & ACT 539 OF 2017 Practical Tips for Compliance ASSOCIATION OF ARKANSAS COUNTIES 2017 Cross, Gunter, Witherspoon & Galchus, P.C. All Rights Reserved. Carolyn B.
More informationCOMPANY ORIENTATION POLICIES AND PROCEDURES
Your next move matters, make it count! COMPANY ORIENTATION POLICIES AND PROCEDURES Congratulations, with this assignment, you are now an employee of ADVANCE CAREER SERVICES (ACS), an Equal Opportunity
More informationCITY OF HOWELL POLICE DEPARTMENT POLICE OFFICER APPLICATION
CITY OF HOWELL POLICE DEPARTMENT POLICE OFFICER APPLICATION RELEASE OF CONFIDENTIAL INFORMATION TO THE CITY OF HOWELL APPLICANT'S NAME: ADDRESS: CITY: STATE: ZIP I respectfully request and authorize any
More informationUniversity ID Number Application Date Telephone Number(s) ( ) ( ) Month Day Year Primary Secondary
UNIVERSITY OF IOWA Transit Coach Operator Employment Application Applicant Name: Email Address: University ID Number Application Date Telephone Number(s) ( ) ( ) Month Day Year Primary Secondary How long
More informationReferred to Committee on Legislative Operations and Elections. SUMMARY Makes various changes relating to the State Personnel System.
S.B. SENATE BILL NO. COMMITTEE ON LEGISLATIVE OPERATIONS AND ELECTIONS (ON BEHALF OF THE DIVISION OF HUMAN RESOURCE MANAGEMENT OF THE DEPARTMENT OF ADMINISTRATION) PREFILED NOVEMBER 6, 08 Referred to Committee
More informationCONSTRUCTION INDUSTRY OF BRITISH COLUMBIA SUBSTANCE ABUSE TESTING TREATMENT PROGRAM POLICY CONSTRUCTION LABOUR RELATIONS ASSOCIATION OF BC
CONSTRUCTION INDUSTRY OF BRITISH COLUMBIA SUBSTANCE ABUSE TESTING AND TREATMENT PROGRAM POLICY DEVELOPED BY: CONSTRUCTION LABOUR RELATIONS ASSOCIATION OF BC AND: BARGAINING COUNCIL OF BRITISH COLUMBIA
More informationThe contents of this sample are not to be regarded as legal advice. individuals with particular questions should seek advice of counsel.
Sample Drug, Alcohol, and Contraband Policy This sample reflects only one generic approach. Legal obligations differ among U.S. jurisdictions and among industries. For purposes of this presentation paper,
More informationEMPLOYMENT APPLICATION
Physical Address: 201 Baldwin Drive / Albany, GA 31707 Mailing Address: P.O. Box 72282 / Albany, GA 31708 T: (229) 317-4911 / T: (877) 794-4911 / F: (866) 396-1173 EMPLOYMENT APPLICATION PERSONAL INFORMATION
More informationA. Code of Conduct Code of Conduct and Disciplinary Actions 3/8/2016
OFFICIAL POLICY 9.1.2 Code of Conduct and Disciplinary Actions 3/8/2016 THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN EMPLOYEES AND THE COLLEGE OF CHARLESTON. THIS DOCUMENT
More information[Escambia County Board of County Commissioners]
[Escambia County Board of County Commissioners] Employee In-Processing SUBSTANCE ABUSE Title: Substance Abuse Policy Section II, Part C.12 Date Adopted: December 16, 1997 Effective Date: August 1, 2016,
More informationSubject: Definitions: None.
Office of Human Resources Standard Operating Procedure HR SOP #403 Subject: Employee Discipline Effective Date: November 16, 2012 Policy Statement: The purpose of this document is to establish a disciplinary
More informationFAIRCHILD APPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT Driver Requirements A driver must meet the following requirements: Be in good health and physically able to perform all duties of a driver. Be at least 21 years of age. Speak
More informationMIRACLE VILLAGE, INC Birmingham Street Tallahassee, F City State Zip. City
MRACLE VLLAGE, NC. 1208 Birmingham Street Tallahassee, F132304 PERSONAL NFORMATON Social Security Number Last Name First Name Middle Name / Present Address Street City State Zip Street City State Zip Home
More informationWheels on the Bus, Inc Disciplinary Guidelines
Wheels on the Bus, Inc Disciplinary Guidelines I. POLICY A. All employees of WOTB are expected to conduct themselves in accordance with applicable laws, regulations, departmental policies and generally
More informationThank you for choosing Harlingen Medical Center for your Volunteer Service!
Harlingen Thank you for your interest in the Harlingen Medical Center Volunteer Services program. Your role will be critical in fulfilling the mission of our Hospital. Enclosed please find the necessary
More informationDISCIPLINE, SUSPENSION AND DISMISSAL OF CLASSIFIED EMPLOYEES
Adopted February 1994 Revised February 2003 Revised March 2008 APS Code: GDQD The Board of Education authorizes the Superintendent to compose and implement regulations relating to the suspension, discipline
More informationQUESTIONS and ANSWERS NW IRONWORKERS DRUG FREE WORKPLACE PROGRAM DRUG AND ALCOHOL TESTING
QUESTIONS and ANSWERS NW IRONWORKERS DRUG FREE WORKPLACE PROGRAM DRUG AND ALCOHOL TESTING 1. WHAT IS THE IRONWORKERS DRUG FREE WORKPLACE PROGRAM? The Northwest Ironworkers Employers Association, Ironworkers
More information1. RADAR EMPLOYMENT APPLICATION 2. CONDITIONS OF EMPLOYMENT 3. RADAR EQUAL OPPORTUNITY FORM
EMPLOYMENT APPLICATIONS FOR RADAR CONSISTS OF 3 PARTS. 1. RADAR EMPLOYMENT APPLICATION 2. CONDITIONS OF EMPLOYMENT 3. RADAR EQUAL OPPORTUNITY FORM ALL PARTS OF THE EMPLOYMENT APPLICATION MUST BE RETURNED
More informationA. Intent. B. Definitions
Article IX.A.2.m. Corrective Discipline A. Intent 1. This program of corrective employee discipline is intended to help promote and maintain a high level of acceptable performance on the part of all classified
More informationEMPLOYMENT APPLICATION PACKAGE #1
A Division of. TECHNICOM SERVICES, INC. EMPLOYMENT APPLICATION PACKAGE #1 Pre-Employment Application Form 1 SECTION I PERMISSIONS AND AGREEMENTS 1. Background Check Permission for Prospective or Current
More informationEQUAL OPPORTUNITY EMPLOYERS
EQUAL OPPORTUNITY EMPLOYERS Please Print Date or application Position (s) Applied For Name Telephone Last First Middle Area Code Address Number Street City Zip State If employed and less than 18 years
More informationOffice of Administrative Services-Human Resources may consult with management as necessary in administering disciplinary action.
SOUTH CAROLINA DEPARTMENT OF ADMINISTRATION DISCIPLINARY POLICY THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE AGENCY. THIS DOCUMENT DOES NOT CREATE
More informationEMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION The Lucky Star and Feather Warrior Casinos are Equal Opportunity Employers and will not discriminate against an applicant or employee on any grounds protected under federal, state,
More informationRULES AND GUIDELINES SEE OUR WEBSITE AT (CLICK ON DRUG FREE WORKPLACE)
RULES AND GUIDELINES SEE OUR WEBSITE AT WWW.LIVEDRUGFREE.ORG (CLICK ON DRUG FREE WORKPLACE) 07-09 SBWC - Drug-Free Workplace Rules & Guidelines for Certification and Annual Recertification Intent of Legislation:
More informationWestern Michigan University Division of Multicultural Affairs Student Employee Manual - Appendices STUDENT EMPLOYEE DISCIPLINARY REPORT
APPENDIX A STUDENT EMPLOYEE DISCIPLINARY REPORT Student Employee Name: : Position/Title: The following disciplinary action was taken: Verbal Written Warning Review of Performance Suspension Dismissal The
More informationPOLICY STATEMENT SUBSTANCE-FREE WORKPLACE
POLICY STATEMENT SUBSTANCE-FREE WORKPLACE It is the policy of FLINTCO, LLC ( Company ) to maintain a work environment that is safe for all persons, including the community, and conducive to attaining high
More informationPOSITION APPLIED FOR: If referred by a current Broward MPO employee, indicate his/her name here:
EMPLOYMENT APPLICATION An Equal Opportunity Employer and a Drug Free Workplace The Broward MPO does not tolerate violence in the workplace. We consider applications for all positions without regard to
More informationCONSTRUCTION TRADES SUBSTANCE ABUSE TESTING & ASSISTANCE PROGRAM
AGC OF WISCONSIN CONSTRUCTION TRADES SUBSTANCE ABUSE TESTING & ASSISTANCE PROGRAM Ironworkers Local Union 383 Wisconsin Laborers District Council Northern Wisconsin Regional Council of Carpenters International
More informationApplicant Personal Information. Name. City State Zip Code. Emergency Contact
Applicant Personal Information Date Name Address Email City State Zip Code Phone Alternate Phone Social Security Number Emergency Contact Date of Birth Phone Position Applying for: Please check box below
More informationAPPLICATION FOR EMPLOYMENT - HVAC
1 APPLICATION FOR EMPLOYMENT - HVAC We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other consideration
More informationSTOP!!! BEFORE YOU MAIL THE ENCLOSED APPLICATION, PLEASE READ THIS! EMPLOYMENT VERIFICATION DOCUMENTS
2 06/2002 FIVE STAR URS SP!!! BEFORE YOU MAIL THE ENCLOSED APPLICATION, PLEASE READ THIS! THE D.O.T. AND COMPANY POLICY BOTH REQUIRE THAT WE VERIFY THE LAST THREE YEARS OF YOUR EMPLOYMENT HISRY. SOMETIMES,
More informationNOTE TO PERSONNEL FILE
NOTE TO PERSONNEL FILE The authority to establish job-related behavior and performance standards derives from the Nevada Revised Statutes Chapter 284 and the Nevada Administrative Code, specifically the
More informationNON-CERTIFIED EMPLOYMENT APPLICATION
For HRO use only Last Name: First Name: MI: Date Received: Expiration: CNMI PUBLIC SCHOOL SYSTEM HUMAN RESOURCES OFFICE NON-CERTIFIED EMPLOYMENT APPLICATION Cover Page LIST OF DOCUMENTS TO ATTACH TO THIS
More informationBurnett Dairy Cooperative State Rd. 70 Grantsburg, WI
Date: Commercial Driver Application An Equal Opportunity Employer Physicals & Drug Screens Required Please fill in ALL Blanks & Provide ALL Information Requested--Print or Type. Name: First Middle Last
More informationAPPLICATION FOR EMPLOYMENT BRAYS ISLAND PLANTATION COLONY, INC. Brays Island is a Drug-Free Workplace
PLEASE PRINT PLAINLY APPLICATION FOR EMPLOYMENT BRAYS ISLAND PLANTATION COLONY, INC. Brays Island is a Drug-Free Workplace Last Name First Middle Social Security No. Address Home Phone Business Phone Age
More informationMonroe County Water Authority
REQUEST FOR QUALIFICATIONS & PROPOSALS Monroe County Water Authority Page 2 SECTION 1 - INVITATION TO PARTICIPATE 1.1 Purpose The Monroe County Water Authority (the Authority) is issuing this Request for
More informationEMPLOYEE CRIMINAL BACKGROUND CHECK
EMPLOYEE CRIMINAL BACKGROUND CHECK A. Purpose The purpose of this policy is to provide for the administration of criminal background checks with respect to employment decisions at The University of Texas
More informationTHE PIPE FITTING COUNCIL OF GREATER CHICAGO SUBSTANCE ABUSE TESTING AND TREATMENT POLICY. Participants:
THE PIPE FITTING COUNCIL OF GREATER CHICAGO SUBSTANCE ABUSE TESTING AND TREATMENT POLICY Participants: Mechanical Contractors Association 7065 Veterans Boulevard, Burr Ridge, Illinois 60527 Phone: 312/384-1220
More informationNO FRILLS PHARMACY, LLC dba HealthMart Pharmacy COMPANY PERSONNEL POLICY MANUAL AND EMPLOYEE HANDBOOK
NO FRILLS PHARMACY, LLC dba HealthMart Pharmacy COMPANY PERSONNEL POLICY MANUAL AND EMPLOYEE HANDBOOK This booklet is distributed for informational purposes and is not to be construed as a contract of
More information