"Drug Free Workplace Policy Employee Acknowledgement Form" - Arkansas

Drug Free Workplace Policy Employee Acknowledgement Form is a legal document that was released by the Arkansas Department of Finance & Administration - a government authority operating within Arkansas.

Form Details:

  • Released on September 1, 2000;
  • The latest edition currently provided by the Arkansas Department of Finance & Administration;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas Department of Finance & Administration.

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Download "Drug Free Workplace Policy Employee Acknowledgement Form" - Arkansas

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EPARTMENT OF
INANCE AND
DMINISTRATION
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RUG
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ORKPLACE
OLICY
Employee Acknowledgment
I, ___________________________________________, an employee of the Department of
(printed name)
Finance and Administration, hereby certify the following:
T I have received a copy of this agency’s policy regarding the maintenance of a drug free
workplace.
T I realize that the unlawful manufacture, distribution, dispensation, possession, or use of a
controlled substance is prohibited on this agency’s premises, and violation of this policy can
subject me to disciplinary action, up to and including termination.
T I realize that as a condition of employment, I must abide by the terms of this policy and will
notify my employer of any criminal drug conviction for a violation occurring in the workplace
no later than five days after such conviction.
T I further realize that, if I am working on a project supported by a federal agency, federal law
mandates that my employer communicate this conviction to the federal agency, and I hereby
waive any and all claims that may arise for conveying this information to the federal agency.
______________________________
Signature
________________________
Date
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EPARTMENT OF
INANCE AND
DMINISTRATION
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ORKPLACE
OLICY
Employee Acknowledgment
I, ___________________________________________, an employee of the Department of
(printed name)
Finance and Administration, hereby certify the following:
T I have received a copy of this agency’s policy regarding the maintenance of a drug free
workplace.
T I realize that the unlawful manufacture, distribution, dispensation, possession, or use of a
controlled substance is prohibited on this agency’s premises, and violation of this policy can
subject me to disciplinary action, up to and including termination.
T I realize that as a condition of employment, I must abide by the terms of this policy and will
notify my employer of any criminal drug conviction for a violation occurring in the workplace
no later than five days after such conviction.
T I further realize that, if I am working on a project supported by a federal agency, federal law
mandates that my employer communicate this conviction to the federal agency, and I hereby
waive any and all claims that may arise for conveying this information to the federal agency.
______________________________
Signature
________________________
Date
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EPARTMENT OF
INANCE AND
DMINISTRATION
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RUG
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ORKPLACE
OLICY
Drug abuse and use at the workplace are subjects of immediate concern in our society. These
problems are extremely complex and ones for which there are no easy solutions. From a safety
perspective, the users of drugs may impair the well-being of all employees, the public at large,
and result in damage to state property. Therefore, it is the policy of the State of Arkansas that
the unlawful manufacture, distribution, dispensation, possession, or use of a controlled
substance in a state agency’s workplace is prohibited. any employees violating this policy will
be subject to discipline up to and including termination. The specifics of this policy are as
follows:
1.
State agencies will not differentiate between drug users and drug pushers or sellers.
Any employee who gives or in any way transfers a controlled substance to another
person or sells or manufactures a controlled substance while on the job or on agency
premises will be subject to discipline up to and including termination.
2.
The term “controlled substance” means any drug listed in 21 U. S. C. Section 812 and
other federal regulations. Generally, these are drugs which have a high potential for
abuse. Such drugs include, but are not limited to, heroin, marijuana, cocaine, PCP, and
“crack”. They also include “legal drugs” which are not prescribed by a licensed
physician.
3.
Each employee is required by law to inform the agency within five days after he or she is
convicted for violation of any federal or state criminal drug statute where such violation
occurred on the agency’s premises. A conviction means a finding of guilt (including a
plea of nolo contendre) or the imposition of a sentence by a judge or jury in any federal
court, state court, or other court of competent jurisdiction.
4.
Pursuant to federal law, if the convicted employee is working on a project supported by a
federal agency, the Department of Finance and Administration must notify the U.S.
government agency with which the contract was made within ten days after receiving
notice from the employee or otherwise receives actual notice of such a conviction.
5.
If an employee is convicted of violating any criminal drug statute while in the workplace,
he or she will be subject to discipline up to and including termination. Alternatively, the
agency may require the employee to successfully finish a drug abuse program
sponsored by an approved private or governmental institution.
6.
As a condition of further employment on any federal government contract, the law
requires all employees to abide by this policy.
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