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The statement requires the applicant to answer whether, within the past three years, they have had any non-negative drug or alcohol pre-employment test result or refused such testing administered by an employer, even if a job offer was withdrawn. If the applicant answers yes, proof of successful completion of DOT return-to-duty requirements must be attached. Employers use the completed statement as part of the Driver Qualification File.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/drug-and-alcohol-testing-statement-for-prospective-employee/270214/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/drug-and-alcohol-testing-statement-for-prospective-employee/270214.png","ImageObject",300,407,{"name":92,"@type":93},"Seraphina","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-15",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What question must prospective employees answer on the statement?","Question",{"text":112,"@type":113},"The applicant must indicate whether, during the past three years, they ever had a non-negative drug or alcohol pre-employment test result or refused to test for a DOT-covered safety-sensitive job, even if the job offer was withdrawn.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"If the applicant answers “YES,” what documentation is required?",{"text":117,"@type":113},"The applicant must provide proof of successful completion of DOT return-to-duty requirements and attach the documentation to the statement.",{"name":119,"@type":110,"acceptedAnswer":120},"Who uses the completed statement and where is it placed?",{"text":121,"@type":113},"The hiring company places the completed pre-employment testing statement in the Driver Qualification File.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},270214,1789455129,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":81},962075114101,"https://ap-avatar.wpscdn.com/avatar/e000253a75eb197efd?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780044092746381165","# Drug and Alcohol Testing Statement for Prospective Employee\n\nCompany Name:                               \nAddress:                                                                                      \nPhone\\#                                                                                      \nPrint name of prospective employee:                      \nSocial Security(or other ID)\\#                         \nProspective employee must answer the following question as required under US DOT 49 CFR Part  \n40.25(j).  \n1.During the past three years,have you ever tested non-negative,or refused to test,on any pre-employment drug or alcohol test administered by any employer to which you applied forsafety-sensitive work covered by DOT Federal Motor Carrier Safety Administration-even ifthe job offer was withdrawn?  \n□ YES□ NO  \n2.If you answered YES,you willneed to provide proof that you have successfully completed theDOT return-to-duty requirements(attach documentation to this Statement)  \nProspective Employee Signature:                   \nDate.           \n\n| 49 CFR Part 40.25()states that employers must ask each prospective employee whether he or  \u003Cbr>she has tested positive,or refused to test,on any pre-employment drug or alcohol test  \u003Cbr>administered by any employer to which the prospective employee applied for a safety-sensitive  \u003Cbr>job under US DOT FMCSA requirements-whether the job offer was withdrawn or not.This also  \u003Cbr>applies to FTA,FAA and Coast Guard.  \u003Cbr>If the prospective employee reports that he or she had a non-negative,or refusal,drug or alcohol  \u003Cbr>pre-employment test,then they cannot be placed in a safety-sensitive position until and unless  \u003Cbr>they provide documentation of successful completion of the return-to-duty process (Sec.4025  \u003Cbr>(b)(5)and(e).   |\n| --- |\n\nPre-employment testing statement for prospective safety-sensitive workers.To be placed by hiring company in Driver Qualification File","cbCaivXtt81E6DV5","https://ap.wps.com/l/cbCaivXtt81E6DV5","pdf",92186,"English","# Drug and Alcohol Testing Statement for Prospective Employee\n## Applicant eligibility questions\n## Documentation for return-to-duty completion\n## Signature and date","[{\"question\":\"What question must prospective employees answer on the statement?\",\"answer\":\"The applicant must indicate whether, during the past three years, they ever had a non-negative drug or alcohol pre-employment test result or refused to test for a DOT-covered safety-sensitive job, even if the job offer was withdrawn.\"},{\"question\":\"If the applicant answers “YES,” what documentation is required?\",\"answer\":\"The applicant must provide proof of successful completion of DOT return-to-duty requirements and attach the documentation to the statement.\"},{\"question\":\"Who uses the completed statement and where is it placed?\",\"answer\":\"The hiring company places the completed pre-employment testing statement in the Driver Qualification File.\"}]","Drug and Alcohol Testing Statement for Prospective Employee | PDF"]