Form MO-580-2767 "Waiver for Employment" - Missouri

Form MO-580-2767 or the "Waiver For Employment" is a form issued by the Missouri Department of Health and Senior Services.

The form was last revised in August 1, 2006 and is available for digital filing. Download an up-to-date Form MO-580-2767 in PDF-format down below or look it up on the Missouri Department of Health and Senior Services Forms website.

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Download Form MO-580-2767 "Waiver for Employment" - Missouri

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MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES
BUREAU OF NARCOTICS AND DANGEROUS DRUGS
WAIVER FOR EMPLOYMENT
A person who has entered a plea of guilty, no contest, nolo contendere , or otherwise been convicted of a criminal
act involving controlled substances, cannot be hired in a position where they have access to controlled
substances, until the registrant/employer has first obtained the required waivers.
Regardless what the sentence or punishment was, this statute applies when a person has entered a plea of
guilty, no contest or nolo contendere , even if the person received a suspended sentence.
When determining whether to grant a waiver of this type, the Bureau shall be fair and consistent in dealing with
all registrants from all professions, according to the provisions set forth in Section 195.040.2, RSMo 2000, which
states:
No registration shall be granted to any person who has within two years been finally adjudicated and
found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of
any state or of the United States, for any misdemeanor offense or within seven years for any felony
offense related to controlled substances. No registration shall be granted to any person who is abusing
controlled substances.
Regulation 19 CSR 30-1.034(2) states:
(2) Other Security.
(A) The registrant shall not employ as an agent or employee who has access to controlled substances any
person who has been found guilty or entered a plea of guilty or nolo contendere in a criminal prosecution under
the laws of any state or of the United States for any offense related to controlled substances or who has had an
application for a state or federal controlled substance registration denied or has had his/her registration revoked
or surrendered for cause at any time. for purposes of this subsection, the term for cause means a surrender in
place of or as a consequence of any federal or state administrative, civil or criminal action resulting from an
investigation of the individual’s handling of controlled substances.
1. A registrant may apply in writing to the Department of Health for a waiver of subsection (2)(A) of this rule
for a specific employee.
2. The Department of Health may issue a written waiver to any registrant upon determination that a waiver
would be consistent with the public health and safety. In making this determination, the Department of Health
shall consider – the duties of the employee, the circumstances surrounding the conviction, the length of time
since the conviction was entered, whether a waiver has been granted by the federal Drug Enforcement
Administration (DEA) pursuant to 21 CFR 1301.76, the security measures taken by the employer to prevent the
theft and diversion of controlled substances, and any other factors consistent with public health and safety.
If the person has been convicted of a misdemeanor, only a waiver from the BNDD is required. If the person
entered a plea of guilty to a felony, a waiver from the United States Drug Enforcement Administration is required
before applying for the state BNDD waiver.
Please answer the questions listed on the attached page and return them to the Bureau of Narcotics and
Dangerous Drugs, P.O. Box 570, Jefferson City, MO 65102-0570. If you have any questions, you may call the
Bureau at (573) 751-6321.
MO 580-2767 (8-06)
PAGE 1
MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES
BUREAU OF NARCOTICS AND DANGEROUS DRUGS
WAIVER FOR EMPLOYMENT
A person who has entered a plea of guilty, no contest, nolo contendere , or otherwise been convicted of a criminal
act involving controlled substances, cannot be hired in a position where they have access to controlled
substances, until the registrant/employer has first obtained the required waivers.
Regardless what the sentence or punishment was, this statute applies when a person has entered a plea of
guilty, no contest or nolo contendere , even if the person received a suspended sentence.
When determining whether to grant a waiver of this type, the Bureau shall be fair and consistent in dealing with
all registrants from all professions, according to the provisions set forth in Section 195.040.2, RSMo 2000, which
states:
No registration shall be granted to any person who has within two years been finally adjudicated and
found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of
any state or of the United States, for any misdemeanor offense or within seven years for any felony
offense related to controlled substances. No registration shall be granted to any person who is abusing
controlled substances.
Regulation 19 CSR 30-1.034(2) states:
(2) Other Security.
(A) The registrant shall not employ as an agent or employee who has access to controlled substances any
person who has been found guilty or entered a plea of guilty or nolo contendere in a criminal prosecution under
the laws of any state or of the United States for any offense related to controlled substances or who has had an
application for a state or federal controlled substance registration denied or has had his/her registration revoked
or surrendered for cause at any time. for purposes of this subsection, the term for cause means a surrender in
place of or as a consequence of any federal or state administrative, civil or criminal action resulting from an
investigation of the individual’s handling of controlled substances.
1. A registrant may apply in writing to the Department of Health for a waiver of subsection (2)(A) of this rule
for a specific employee.
2. The Department of Health may issue a written waiver to any registrant upon determination that a waiver
would be consistent with the public health and safety. In making this determination, the Department of Health
shall consider – the duties of the employee, the circumstances surrounding the conviction, the length of time
since the conviction was entered, whether a waiver has been granted by the federal Drug Enforcement
Administration (DEA) pursuant to 21 CFR 1301.76, the security measures taken by the employer to prevent the
theft and diversion of controlled substances, and any other factors consistent with public health and safety.
If the person has been convicted of a misdemeanor, only a waiver from the BNDD is required. If the person
entered a plea of guilty to a felony, a waiver from the United States Drug Enforcement Administration is required
before applying for the state BNDD waiver.
Please answer the questions listed on the attached page and return them to the Bureau of Narcotics and
Dangerous Drugs, P.O. Box 570, Jefferson City, MO 65102-0570. If you have any questions, you may call the
Bureau at (573) 751-6321.
MO 580-2767 (8-06)
PAGE 1
BNDD WAIVER QUESTIONNAIRE
1. NAME, DATE OF BIRTH, SOCIAL SECURITY NUMBER AND HOME ADDRESS OF THE EMPLOYEE
2. A STATEMENT FROM THE EMPLOYEE DESCRIBING THE CIRCUMSTANCES AROUND THEIR CRIME OR ADMINISTRATIVE DISCIPLINARY ACTION.
3. THE COUNTY AND STATE OF THE GUILTY PLEA OR CONVICTION, THE DATE OF THEIR CONVICTION AND THE EXACT CHARGES THAT THE DEFENDANT PLED TO.
4. WHAT WAS THE FINAL JUDGMENT AND SENTENCE ISSUED BY THE CRIMINAL COURT OR FINAL DISCIPLINE ISSUED BY THE ADMINISTRATIVE BODY IMPOSING
REGULATORY DISCIPLINE?  
5. WAS THE CRIME/CONVICTION A MISDEMEANOR OR FELONY? IF THE CRIME WAS A MISDEMEANOR, YOU MAY PROCEED WITH THIS PROCESS. IF THE
CRIME/CONVICTION WAS A FELONY, YOU MUST FIRST OBTAIN A WAIVER FROM THE UNITED STATES DRUG ENFORCEMENT ADMINISTRATION (DEA) AND
SUBMIT THE DEA WAIVER FOR THE BUREAU’S CONSIDERATION. IF YOUR DISCIPLINE WAS NOT A CRIMINAL CHARGE, BUT VOLUNTARY SURRENDER FOR
CAUSE, OR A REVOCATION OR DENIAL OF YOUR CONTROLLED SUBSTANCE REGISTRATION, YOU MUST ALSO OBTAIN A WAIVER FROM THE DEA FOR
SUBMISSION TO THE BUREAU.
6. WHAT ARE THE DUTIES OF THE EMPLOYEE? WHAT ACCESS TO CONTROLLED SUBSTANCES DO THEY HAVE?
7. WHAT EXTRA SECURITY MEASURES HAS THE EMPLOYER TAKEN TO PREVENT THEFT AND DIVERSION? (i.e. cameras, monitors, perpetual inventory, routine audits,
random drug testing, not allowing the employee to work unsupervised)
8. IF THE EMPLOYEE IS A LICENSED PROFESSIONAL (i.e. physician or pharmacist) IS THEIR PROFESSIONAL LICENSING BOARD AWARE OF THE CRIME/CONVICTION?
9. NAME OF REGISTRANT AND NAME OF EMPLOYER REQUESTING THE WAIVER.
MO 580-2767 (8-06)
PAGE 2
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