SOP 104.59-att-1: Drug Test Awareness Statement_Notification

SOP 104.59
Attachment 1

(10/30/17)

MEMORANDUM

TO: Employee Name and SSN

FROM: Appointing Authority Name/Title

SUBJECT: DRUG TEST AWARENESS STATEMENT/NOTIFICATION
(PRE-EMPLOYMENT)

DATE: Date Being Issued

Your employment, in the position offered, is contingent upon passing a drug test.

The initial drug test will be administered on-site. If this test confirms a negative result, the pre-employment drug
test procedure is complete. If the on-site drug test cannot confirm a negative result, you will be required to report
to a urine collection and drug-testing site no later than (MONTH, DATE AND YEAR HERE) to provide the
necessary urine sample. You must take a picture ID and the Custody and Control Form with you when you
report to the site. We will provide you with this form. Upon being tested, you will return copies 1 & 2 of the
Custody and Control form to your local HR office, preferably immediately, but no later than two business days
after testing. Copy 3 will be for your personal records.

If you test "positive", expressly refuse to take the drug test, fail to appear for this test, or fail to produce a
sufficient urine sample by the specified deadline, this employment offer will be withdrawn. If you are a current
State of Georgia employee, your current agency will be contacted with the positive result by Correction Human
Resource Management (CHRM). If you are a GDC employee, a positive test result may end in dismissal.

Print Employee Name

Print Employee Name Employee ID (if applicable) Employee SSN#

Employee Signature Date

Employee ID (if applicable)

Date

Retention Schedule: Upon completion, this form shall be retained permanently in the employee’s local and official personnel
file. If not hired, the form shall be retained in the Interview/Selection file for twos (2) calendar years.