Policy 5227F - Acknowledgement of Receipt of Drug Testing Program And Agreement to Abide By The Program

I, ___________________________________________________________________, hereby acknowledge that I have received a copy of the Drug Testing Program. In conjunction with my receiving a copy of the Kimberly School District’s Drug Testing Program, I further acknowledge the following: I have read the program and fully understand the terms contained therein, and the consequences for violating any terms of the program. I understand that my compliance with all terms of the program is a condition of my employment with the Kimberly School District to abide by all terms of the program. I authorize the lab and/or Medical Review Officer retained by the district to release test result information to the Kimberly School District. ______________________________________________ ___________________ Employee’s Signature Date Witnessed by: Kimberly Public Schools #414 By: ___________________________________________ Date: ____________________________________