SOP 104.58-att-4: Sample Letter - Drug Dismissal (Unclassified Employee)
Summary
Key Topics
- drug dismissal
- drug testing
- employee termination
- unclassified employee
- illegal drug use
- drug test refusal
- adverse action
- Medical Review Officer
- employment disqualification
- disciplinary action
- appeal process
Full Text
SOP 104.58
Attachment 4
8/19/20
SAMPLE LETTER
DRUG DISMISSAL
UNCLASSIFIED EMPLOYEE
Date
Employee's Name
Address
City/State/Zip
Dear _______________ :
On (INSERT DATE) y ou were notified that you must report for a drug test.
_(CHOOSE ONLY ONE OF THE FOLLOWING STATEMENTS):_
Based on the results of that drug test, the Medical Review Officer has:
Determined that you illegally used the drug ( INSERT THE DRUG NAME )___
# OR
You refused to report for the drug test.
Therefore, you are being dismissed from employment as a ( INSERT JOB TITLE) with the
Georgia Department of Corrections effective (INSERT DATE) . In addition, as a result of this action you
are disqualified from consideration for future employment with the State of Georgia for a minimum
period of two (2) years from the effective date of this action.
NOTE: T he Appointing Authority will determine what action to take on a Non-P.O.S.T. certified
employee. The employee will be subject to a disciplinary action, up to and including dismissal.
You may request a review of this dismissal by responding, in writing, within five (5) business days
of the receipt of this letter to:
Commissioner's Designee for Adverse Action
State Office South – Tift Campus
P. O. Box 1529
Forsyth, Georgia 31029
Phone: 478-992-5211
Fax: 478-992-5178
Sincerely,
Name of Appointing Authority
Title
cc: Director, Human Resources
Commissioner's Designee for Adverse Action
CHRM Adverse Action Coordinator
CHRM Drug Testing Coordinator
Retention Schedule: Upon completion, this form shall be retained permanently in the employee’s official and local personnel files.