(This should be a separate page which the employee reads, signs, and which both the employee and the employer keep on file. This same sheet applies to all three sample policies.)

I acknowledge that I have received a copy of the Drug-Free Workplace Policy. I also acknowledge that the provisions of the Policy are part of the terms and conditions of my employment and that I agree to abide by them.

Date:
Signature of Employee:
Print Name :
Employee Social Security Number: