Form CALHR164 "Calhr Substance Abuse Program Federal Drug and Alcohol Random Testing Pool Addition/Deletion" - California

What Is Form CALHR164?

This is a legal form that was released by the California Department of Human Resources - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2019;
  • The latest edition provided by the California Department of Human Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CALHR164 by clicking the link below or browse more documents and templates provided by the California Department of Human Resources.

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Download Form CALHR164 "Calhr Substance Abuse Program Federal Drug and Alcohol Random Testing Pool Addition/Deletion" - California

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CalHR Substance Abuse Program
Federal Drug and Alcohol
Random Testing Pool Addition/Deletion
California Department of Human Resources
State of California
Date
Document Processing
Person adding employee to testing pool
Phone Number
Email
Department
District / Division
Add
Transfer
From District/Division:
To District/Division:
Delete (Inactive)
Reason:
Retired Date:
Separated Date:
Employee Quit Program
Removed from Program by Department (Explain in Comments section below.)
Employee Information
Name (Last, First, MI)
Alternate ID
Position Number
Work Location Zip Code Pool Type
Driver
Crew
Sensitive Position
Employee is a Supervisor
Collective Bargaining Unit
CDL Number
CDL Expiration Date
Yes
No
Comments (If employee was removed from the program by the Department, state the reason.)
Prepared by
Title
Phone number
CalHR 164
(new 2/2019)
Page 1 of 1
CalHR Substance Abuse Program
Federal Drug and Alcohol
Random Testing Pool Addition/Deletion
California Department of Human Resources
State of California
Date
Document Processing
Person adding employee to testing pool
Phone Number
Email
Department
District / Division
Add
Transfer
From District/Division:
To District/Division:
Delete (Inactive)
Reason:
Retired Date:
Separated Date:
Employee Quit Program
Removed from Program by Department (Explain in Comments section below.)
Employee Information
Name (Last, First, MI)
Alternate ID
Position Number
Work Location Zip Code Pool Type
Driver
Crew
Sensitive Position
Employee is a Supervisor
Collective Bargaining Unit
CDL Number
CDL Expiration Date
Yes
No
Comments (If employee was removed from the program by the Department, state the reason.)
Prepared by
Title
Phone number
CalHR 164
(new 2/2019)
Page 1 of 1