PDT Pre-Employment Alcohol and Drug Statement

Pre-Employment Alcohol and Drug Statement

Section 40.25(j). As a motor carrier, we must also ask the prospective driver whether he/she has ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the applicant applied for, but did not obtain safety sensitive transportation work covered by Department of Transportation Agency drug and alcohol testing rules during the past two years. If the driver admits that he/she has had a positive test or a refusal to test, we must not use the driver to perform safety sensitive functions for us, until and unless the potential driver documents successful completion of the return to duty process. See section 40.25 (b) (5) and (3).

Prospective Driver is required to respond honestly to the following questions:

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain safety sensitive transportation work covered by Department of Transportation Agency drug and alcohol testing rules during the past two years?

YesNo

Have you ever tested positive, or refused to test on any random, post-accident, reasonable suspicion, or other substance abuse test covered by Department of Transportation Agency drug and alcohol testing rules during the past two years?

YesNo

If yes, can you provide/obtain proof that you have successfully completed the required Department of Transportation return to duty requirements?

N/AYesNo

Print Name

Social Security Number

Signature

Date