08_DrugAlcoholStatement

PREVIOUS PRE-EMPLOYMENT DRUG & ALCOHOL STATEMENT
Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by the DOT agency drug and alcohol testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process. (See Sec. 40.25(b5) and (e))
Prospective EmployeeContractor Name
Social Security Number
The prospective employee/contractor is required by Sec. 40.25(j) to respond to the following questions:
1) Have you 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 DOT agency drug and alcohol testing rules during the past two years? Check one:

YESNO
If you answered yes, can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements? Check one:

YESNONot Applicable
I certify that the information provided on this document is true and correct.
Signature

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Witnessed By Signature

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BRAVO MOTOR CARRIERS INC
ACKNOWLEDGEMENT & EMPLOYEE COMMITMENT

I, the undersigned, certify that I have read and understand BRAVO MOTOR CARRIERS INC Statement of Policy on Drug and Alcohol Abuse and have received a copy of the policy. By accepting employment with the Company, I also consent to submit to urine, breath, and/or saliva for the testing of alcohol, drugs, and controlled substances and I agree to comply with all of the requirements of the Company, and with state or local laws and rules governing the use of drugs and controlled substances.

Iunderstand that my failure to honor the terms of this Agreement will be grounds for the termination of my employment or the consideration of my application for employment.

I further understand that, notwithstanding the policy or this Acknowledgement and Employee Commitment, employment is at will, that the terms of my employment or employment itself may be terminated as the Company may choose in its sole discretion, that the Policy does constitute a contractual commitment or binding legal obligation on the Company and that the Policy does not create an employment contract between the Company and me.
EmployeeContractor Signature

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Printed Name
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CONSENT FOR DOT MANDATED CONTROLLED SUBSTANCE AND ALCOHOL TEST

The Federal Motor Carrier Safety Regulations, Section 382.113 before performing an alcohol or controlled substance test under this part (382), each employer shall notify a driver that the alcohol or controlled substance test is required by part 382-Controlled Substance and Alcohol use and Testing.

Pre-Employment testing requirements: (a) Prior to the first time a driver-applicant performs safety-sensitive functions for an employer, the driver shall undergo testing for controlled substance.

382.306Reasonable Suspicion Testing

As a condition of my employment: I agree to controlled substance test for the drugs (Marijuana, Cocaine, Phencyclidine "PCP", Opiates, and Amphetamines) and Alcohol Test as required by part 382. I understand a positive test for controlled substance or an Alcohol 0.04 or greater Alcohol concentration, will disqualify me from operating a commercial motor vehicle for this company.

This consent is given voluntarily in exchange for the employer's verification that testing will be required in accordance with Part 382.

I have read and understand the above conditions.
Applicants Name
Applicants Signature

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Company Representatives Signature

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