Appendix E - Controlled Substance and Alcohol Questionnaire
Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?
Have you successfully completed the return-to-duty process?
Documentation MUST BE PROVIDED before any safety-sensitive transportation function is performed.
To be completed by the employer
Application reviewed for completeness by:
Application reviewed by:
Thank you for your submission!