Drug Free Affidavit.pdf

This document is a Drug Free Workplace Conformance Affidavit from the State of West Virginia, specifically referencing West Virginia Code §21-1D-5. The form is designed for an employee to attest that their company maintains a written drug-free workplace policy that complies with state regulations. The form requires the employee to fill in details about their company and personally swear under penalty of perjury that they understand and support the drug-free workplace policy.

The document, approved on April 30, 2020 and revised on July 7, 2017, is an official state form (labeled WV-73) that includes spaces for a notary public to validate the sworn statement. It requires the signatory to provide their printed name, signature, title, company name, and date of execution. The form also includes a section for county and notary details, with space for the notary's seal and commission expiration date. This affidavit is a standard compliance document that companies likely must complete when bidding on state contracts or as part of their ongoing business interactions with West Virginia government entities.