Free CERTIFICATION OF EMPLOYER.PDF - Arizona

CERTIFICATION OF EMPLOYER' S DRUG AND ALCOHOL TESTING POLICY
The undersigned employer certifies, pursuant to A.R.S. §23-1021(D) & (F), that the employer has established a policy of drug testing or alcohol impairment testing in accordance with Chapter 2, Article 14, Title 23, and is maintaining that policy on an ongoing manner. The undersigned employer also certifies that the employer has provided notification to its employees in a manner consistent with A.R.S. §23-493.04 (A) that the employer is maintaining the above referenced policy. Employer Name: FEIN #: (REQUIRED) All Subsidiaries: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ All Locations Covered: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________

Signed: _______________________________Dated:______________
Mail to: Industrial Commission of Arizona Claims Division (Admin. Section) P.O. Box 19070 Phoenix, AZ 85007

THE INDUSTRIAL COMMISSION COMPLIES WITH THE AMERICANS WITH DISABILITIES ACT OF 1990. IF YOU NEED THIS DOCUMENT IN ALTERNATIVE FORMAT, CONTACT SPECIAL SERVICES AT (602) 542-5991.