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Drug Free Workplace

Note: Any entity, whether an agency or an individual, must complete, sign, and return this certification with its grant application to the California Department of Education.

Grantees Other Than Individuals

As required by Section 8355 of the California Government Code and the Drug-Free Workplace Act of 1988, and implemented at 34 Code of Federal Regulations ( CFR ) Part 84, Subpart F, for grantees, as defined at 34 CFR Part 84, Sections 84.105 and 84.110

1. The applicant certifies that it will or will continue to provide a drug-free workplace by:
   1. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition
   2. Establishing an on-going drug-free awareness program to inform employees about:
      1. The dangers of drug abuse in the workplace
      2. The grantee's policy of maintaining a drug-free workplace
      3. Any available drug counseling, rehabilitation, and employee assistance programs
      4. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace
   3. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a)
   4. Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will:
      1. Abide by the terms of the statement
      2. Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than 5 calendar days after such conviction
   5. Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee. Notice shall include the identification
      number(s) of each affected grant.
   6. Taking one of the following actions, as to any employee who is convicted, within 30 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction:
      1. Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973 (29 U.S.C.Section 794), as amended; or
      2. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency
   7. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f).
2. The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant: Grantee must ensure all such site(s) are identified.

Place of Performance (street address. city, county, state, zip code)

____________________________________________________

____________________________________________________

____________________________________________________

Check [ ] if there are workplaces on file that are not identified here.

Grantees Who Are Individuals

As required by Section 8355 of the California Government Code and the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 84, Subpart F, for grantees, as defined at 34 CFR Part 84, Sections 84.105 and 84.110

1. As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; and
2. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction to every grant officer or designee, in writing, within 10 calendar days of the conviction. Notice shall include the identification number(s) of each affected grant.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.

Name of Applicant: ____________________________________________________________________

Name of Program: ____________________________________________________________________

Printed Name and Title of Authorized Representative: __________________________________________

Signature: ________________________________________________ Date: ______________________

CDE-100DF (May-2007) - California Department of Education