DRUG FREE AFFIDAVIT.pdf

This is a Drug Free Workplace Conformance Affidavit required by the State of West Virginia pursuant to West Virginia Code 21-1D-5. The affidavit serves as a declaration of compliance with the state's drug-free workplace requirements and must be completed by an employee authorized to attest on behalf of their company. The form requires the employee to confirm that their company maintains a written drug-free workplace policy and plan that complies with West Virginia Code 21-1D. The affidavit must be notarized and includes spaces for the employee's printed name, signature, title, company name, and the date of execution.

The affidavit must be sworn before a notary public and includes standard attestation language regarding penalty of perjury. The notary section requires the notary's printed name, title, commission expiration date, county jurisdiction, and the date the oath was administered. This form was approved on April 30, 2020, with the most recent revision dated July 7, 2017. The affidavit is a mandatory submission requirement for state and local contract opportunities in West Virginia and does not involve pricing, set-asides, or specific funding amounts but rather serves as a compliance verification document.