I, (__________________________________), hereby provide consent to Spirit Lake Community School District to conduct a limited query of the FMCSA, Commercial Driver’s License Drug and Alcohol Clearinghouse, to determine whether drug or alcohol violation information about me exists in the Clearinghouse.
I consent to multiple limited queries to be conducted for the duration of my employment.
I understand that if the limited query conducted by Spirit Lake Community Schools indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Spirit Lake Community Schools without first obtaining additional specific consent from me.
I further understand that if I refuse to provide consent for Spirit Lake Community Schools to conduct a limited query of the Clearinghouse, Spirit Lake Community Schools must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
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Employee Signature Date
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Approved: 2/10/20 |
Reviewed: |
Revised: |