W. Va. Code R. § 126-8-6
West Virginia Department of Education
DRUG-FREE WORKPLACE VERIFICATION STATEMENT
NAME: ________________________________
EMPLOYEE IDENTIFICATION NUMBER: ___________________
ADDRESS: ______________________________ TELEPHONE NUMBER: _____________________
Date Employed by West Virginia Department of Education: _________________________
I, _______________________________, certify that I have received a copy of West Virginia Board of Education Policy 1461, Drug-Free Workplace.
As an employee of the West Virginia Department of Education, I agree to comply with Policy 1461 which states that the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance and/or alcohol is prohibited in the workplace. Additionally, I shall not report for work while under the influence of alcohol and/or an illegal drug.
The workplace shall be defined as a worksite where work is performed in connection with the employee's West Virginia Department of Education employment. The workplace shall include but not be limited to facilities, property, buildings, offices, structures, automobiles, trucks, trailers, other vehicles, and parking areas, whether owned or leased by the agency or entity.
The policy is applicable while employees are engaged in any work-related activity which includes performance of agency business during regularly scheduled workdays, meal breaks, and/or occasions having an official connection with the job or the agency.
In addition, I understand that, as a condition of employment, I shall notify my supervisor of any criminal drug or alcohol violation occurring in the workplace or conviction outside of the workplace, no later than five days after such violation or conviction occurs.
________________________
Employee Signature
___________________________
Date
W. Va. Code R. § 126-8-6