GBEC-E-3

I have been given and read the West Springfield School District Drug-Free Workplace Statement/Policy (File: GBEC) along with Employee Assistance Program (File GBEC-E-1) and Employee Conviction Report (File: GBEC-E-2). I understand that this acknowledgment and agreement are required as a condition of continued employment.

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Signature Date

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Print Name

NOTE: Title updated to reflect title change in policy (File: GBEC) 8/30/16