DOT Drug and Alcohol Class for Employees Submission

DOT Drug and Alcohol Class for Employees Submission form

Please complete the form below and attach the required items to begin the course. The items to attach are:

1. Clearing House Policy of Procedures Form
2. Pre-Employment Notification and Acknowledgement Form
3. Copy of your Driver License

Any questions or issues please contact EZDOT, LLC at (912) 437-8378 or dr.tanja.payne@ezdot.org

Name *

First

Last

Current Residential Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone Number *

Are you associated with a company or school? *

College
Online Refresher
Company

Course Attachments *

Click or drag files to this area to upload. You can upload up to 3 files.

Please submit the