EZDOT Training Forms

DOT Drug and Alcohol Class for Employees Submission Form

Name *

First

Last

Current Residential Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone Number *

Please enter your current phone number

Are you associated with a company or school? *

College
Company

Select one of the option that applies to you

Attach CDL Permit *

Drag & Drop Files, Choose Files to Upload

Please attach a copy of your CDL Permit for the course.

Clearing House Policy of Procedures Form

Certification of Receipt of the “Employer”(Herein after called “Employer”) DOT Policy of procedures for Drug and Alcohol Testing of Student Employees and Employees in positions requiring a Commercial Learner’s Permit, Commercial Driver’s License or otherwise holding a safety sensitive position.

I hereby certify that in accordance with Title 49, Part 382.601 and Part 382 of the Code of Federal Regulations (CFR), I have been provided a copy of “Employer” policy of procedures on drug and alcohol testing and program of student employees and employees in positions requiring a Commercial Learner’s Permit (CLP), Commercial Driver’s License (CDL) or in a safety sensitive position. I understand that it is the policy of procedures of “Employer” that student employees and employees, who are required to obtain and hold a CLP or CDL or perform in a safety sensitive position as a condition of continued employment and/or enrollment, will comply with all Federal regulatory requirements for drug and alcohol testing as detailed in Title 49 CFR.

General Consent for Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse.

I hereby provide consent to “Employer”/EZDOT conduct queries 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 understand that if the queries conducted by “Employer”/EZDOT indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to anyone without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for “Employer”/EZDOT to conduct queries of the Clearinghouse, “Employer”/EZDOT must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

“Employer” has a ZERO tolerance against any violation of this policy of procedures. Student Employees and Employees are also governed by the “Employer” Non-DOT Policy of procedures!

By signing below, student acknowledges receipt and/or signing all of the following:

A copy of “Employer “DOT drug and alcohol policy of procedures.
DOT “What employees need to know”
Drug and Alcohol Awareness class
Acknowledgement and Notification
I provide consent to “Employer” to conduct Queries for the duration of my employment

NOTE: Choose "Employer" below to confirm your acceptance of above agreement.

Choose your company or school? *

College
Company

Select one of the option that applies to you

Student Name *

First

Last

any in Name

Student Signature *

Clear Signature

Date *

Permit Number *

State Issued *

Preferred Email Address *

DOT Drug and Alcohol Class for Employees Submission Form

Clearing House Policy of Procedures Form

Pre-Employment Notification and Acknowledgement Form