Drug & Alcohol Background Check Form

Form Template

 Drug & Alcohol Background Check Form 

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In the Drug & Alcohol Background Check Form application the employee gives the employer the authorization to perform a drug & alcohol background check. It is a simple and efficient way to collect and store the authorizations by employer and organizations.

A new employee or job applicant authorize a release of information from my Department of Transportation regulated drug and alcohol testing records by his previous employer, listed in Section I-B, to the employer listed in Section I-A. This release is in accordance with DOT Regulation 49 CFR Part 40, Section 40.25 and 391.23. Employees understand that information to be released in Section II-A by his previous employer, is limited to the following DOT-regulated testing items:

1. Alcohol test with a result of 0.04 or higher;

2. Verified positive drug test;

3. Refusals to be tested;

4. Other violations of DOT agency drug and alcohol testing regulations;

5. Information obtained from previous employers of a drug and alcohol rule violation;

6. Documentation, if any, of completion of the return-to-duty process following a rule violation.

As an employer, you must, after obtaining an employee’s written consent, request the information about the employee listed in paragraph (b) of this section. This requirement applies only to employees seeking to begin performing safety-sensitive duties for you for the first time (i.e., a new hire, an employee transfer into a safety-sensitive position). If the employee refuses to provide this written consent, you must not permit the employee to perform safety-sensitive functions. 

If you want more forms like this, take a look at our criminal background check app.

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