"WEST GULF MARITIME ASSOCIATION INTERNATIONAL LONGSHOREMEN S ASSOCIATION POLICY ON DRUGS"
WEST GULF MARITIME ASSOCIATION/INTERNATIONAL LONGSHOREMEN'S ASSOCIATION POLICY ON DRUGS NOTIFICATION FOR DRUG TEST EMPLOYEE: (Last Name) (First Name) (MI) SSN Drivers License # (Address) (City) (State) (Zip) is hereby notified to appear as soon as possible, but not to exceed six (6) hours at: (Medical Facility/Laboratory) (Address) for a drug test in keeping with the WGMA/ILA Policy on Drugs. Failure to submit to a drug test as specified herein or sign all required forms shall invoke the penalties for violating the WGMA/ILA Policy on Drugs. BILL TO EMPLOYER: (Address) (City) (State) (Zip) (Phone #) Date of Notice: Time of Notice: A.M./P.M. Time Given to Report to Medical Facility / Laboratory: A.M./P.M. Location of Notice: Employee's Union Local #: Employee's Job: Reason for drug screen notification: □ Alleged Injury/Illness To Person Named Above □ Other Superint/Manager: (Signature) ATTENTION EMPLOYEE Employee: PHOTO I.D. (Signature) Required for Witness: (Signature) DRUG TEST WHITE-WGMA / YELLOW- EMPLOYEE / PINK - EMPLOYER (3) COPIES REQUIRED FOR DISTRIBUTION