DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT.pdf
PDF 78 KB Posted
- Solicitation number
- ARFQ-0512-MHC2500000001-2
- Issued by
- Marshall County, West Virginia
About this file
This document is a Drug Free Workplace Conformance Affidavit required by the State of West Virginia. It attests that the company maintains a written plan for a drug-free workplace policy in compliance with West Virginia Code 21-1D. The affidavit must be signed and notarized. No other details about a specific contract opportunity are provided in this document.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
WV-73
Approved / April 30, 2020
State of West Virginia
DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT
West Virginia Code §21-1D-5
I, , after being first duly sworn, depose and state as follows:
1. I am an employee of ; and, (Company Name)
2. I do hereby attest that (Company Name) maintains a written plan for a drug-free workplace policy and that such plan and policy are in compliance with West Virginia Code §21-1D.
The above statements are sworn to under the penalty of perjury.
Printed Name:
Signature:
Title:
Company Name:
Date:
STATE OF WEST VIRGINIA,
COUNTY OF ____________________________, TO-WIT:
Taken, subscribed and sworn to before me this day of , .
By Commission expires
(Seal)
(Notary Public)
Rev. July 7, 2017
File details come from the government source that posted it. Updated .