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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 /> DRUG AND ALCOHOL FREE WORKPLACE <br /> POLICY RECEIPT <br /> I hereby acknowledge that I have received a copy of The City of Batesville Drug and <br /> Alcohol Free Workplace Policy. I understand that it is my responsibility to read this <br /> policy and question my supervisor regarding any aspect of the policy that I do not <br /> understand. I further-understand that compliance with the requirements of the policy is a <br /> condition of employment with The City of Batesville <br /> I also understand the return of this Policy Book in good condition is mandatory before I <br /> receive my final payroll check or pay a$5.00 charge for the Policy Book. <br /> Employee (Print) Employee Name (Signature) <br /> I <br /> i <br /> Date Social Security Number <br /> Witness (Print) Witness (Signature) <br /> F <br /> a <br /> 10 <br />