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2. Employee Confirmation of Receipt

   I hearby certify that I was given, and have read, a copy of the Town of Wilbraham Drug and Alcohol Testing Policy, and that I have been given an opportunity to ask questions of my supervisor about the content of the policy.

4. Employee's Name*
6. Department*
8. Electronic Signature Agreement*

   By checking the "I agree" box below, you agree and acknowledge that 1) your acknowledgement will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

   1. I agree

   1. I DO NOT agree
10. Employee Signature*
12. Date*
    Date
Leave This Blank:


14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit Submit and Print

* indicates a required field