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EMPLOYEE RECEIPT FORM <br />CONTROLLED SUBSTANCE AND ALCOHOL ABUSE POLICY <br />Employee Name: <br />Division/Department: <br />Employee Number: <br />Supervisor's Name: <br />4 01 <br />By signing this form, I hereby acknowledge that I have received an updated copy of the City of <br />Paris's Controlled Substance and Alcohol Abuse Policy for employees. I further state That I am <br />aware that I am required, as an employee of the City, to familiarize myself with and comply with <br />the terms and provisions of this Policy, and I further state that I understand that this form which I <br />sign will be placed in my personnel file indicating receipt. of the Policy and acknowledging my <br />i responsibility to thoroughly familiarize myself with and comply with the Policy. <br />Employee Signature <br />Date <br />84 Revised 01 -25 -05 <br />