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® CITY OF BATESVILLE <br /> 500 EAST MAIN <br /> BATESVILLE, ARKANSAS 72501 <br /> Phone 870-698-2400 <br /> Fax 870-698-2406 <br /> SUPERVISOR TRAINING ATTENDANCE CERTIFICATION <br /> In accordance with my Employer's Drug and Alcohol Free Workplace policy, I herein <br /> acknowledge that I have received training and understand my obligations. <br /> I understand that the use or possession of alcohol in any form is prohibited in the <br /> workplace, and that there are restrictions on alcohol use prior to reporting for work and <br /> after an accident. <br /> I understand that the possession or use of unauthorized or illegal drugs is prohibited at <br /> any time whether in the workplace or not. <br /> As a condition of employment, I understand that I must submit to random testing for <br /> ( alcohol and drugs, and must submit to collection or breath and saliva samples when <br /> requested by my Employer or a Employer designee. I also understand that I maybe <br /> ` subject to drug and alcohol testing in other circumstances, including,but no limited to <br /> post-accident and reasonable suspicion. <br /> Employee: <br /> Printed Name Signature <br /> Social Security Number Date <br /> a <br /> Gi <br /> ti <br /> 14 <br />