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<br />DRAFT <br /> <br />Attachment 4 <br /> <br />EMPLOYEE RECEIPT FORM <br />CONTROLLED SUBSTANCE AND ALCOHOL ABUSE POLICY <br /> <br />Employee Name: <br /> <br />DivisionlDepartment: <br /> <br />Employee Number: <br /> <br />Supervisor's Name: <br /> <br />By signing this form, I hereby acknowledge that I have received an updated copy of the City <br />of Paris's Controlled Substance and Alcohol Abuse Policy for employees. I further state <br />that I am aware that I am required, as an employee of the City, to familiarize myself with <br />and comply with the terms and provisions of this Policy, and I further state that I <br />understand that this form which I sign will be placed in my personnel file indicating receipt <br />of the Policy and acknowledging my responsibility to thoroughly familiarize myself with and <br />comply with the Policy. <br /> <br />Employee Signature <br /> <br />Date <br /> <br />74 <br /> <br />Rev. 10/27/04 <br />