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(1) Abide by the terms of the statement; and
<br />(2) Notify the employer in writing of his or her conviction for a
<br />violation of a criminal drug statute occurring in the workplace
<br />no later than five calendar days after such conviction;
<br />Check ❑ if there are workplaces on file that are not indentified
<br />(a) Notifying the agency, in writing, within 10 calendar days
<br />here.
<br />after receiving notice under subparagraph (d)(2) from an
<br />employee or otherwise receiving actual notice of such convic-tion.
<br />Section 67, 630 of the regulations provides that a grantee that
<br />Employers of convicted employees must provide notice, including
<br />is a State may elect to make one certification in each Federal
<br />fiscal year. A copy of which should be included with each ap-
<br />position title, to: Department of Justice, Office of
<br />Justice Programs, ATTN: Control Desk, 633 Indiana Avenue,
<br />plication for Department of Justice funding. States and State
<br />N.W., Washington, D.C. 20531. Notice shall include the iden-
<br />agencies may elect to use OJP Form 4061/7.
<br />tification number(s) of each affected grant;
<br />Check ❑ if the State has elected to complete OJP Form
<br />(f) Taking one of the following actions, within 30 calendar
<br />4061/7.
<br />days of receiving notice under subparagraph (d)(2), with
<br />respect to any employee who is so convicted—
<br />DRUG -FREE WORKPLACE
<br />(1) Taking appropriate personnel action against such an
<br />(GRANTEES WHO ARE INDIVIDUALS)
<br />employee, up to and including termination, consistent with the
<br />As required by the Drug -Free Workplace Act of 1988, and
<br />requirements of the Rehabilitation Act of 1973, as amended; or
<br />implemented at 28 CFR Part 67, Subpart F, for grantees, as
<br />(2) Requiring such employee to participate satisfactorily in a
<br />defined at 28 CFR Part 67; Sections 67,615 and 67.620—
<br />drug abuse assistance or rehabilitation program approved for
<br />such purposes by a Federal, State, or local health, law enforce-
<br />A. As a condition of the grant, I certify that I will not engage
<br />ment, or other appropriate agency;
<br />in the unlawful manufacture, distribution, dispensing, posses-
<br />sion, or use of a controlled substance in conducting any
<br />(g) Making a good faith effort to continue to maintain a drug-
<br />activity with the grant; and
<br />free workplace through implementation of paragraphs (a), (b),
<br />(c), (d), (e), and (f).
<br />B. If convicted of a criminal drug offense resulting from a
<br />violation occurring during the conduct of any grant activity, I
<br />B. The grantee may insert in the space provided below the
<br />will report the conviction, in writing, within 10 calendar days
<br />site(s) for the performance of work done in connection with
<br />of the conviction, to: Department of Justice, Office of Justice
<br />the specific grant:
<br />Programs, ATTN: Control Desk, 633 Indiana Avenue, N.W.,
<br />Place of Performance (Street address, city, county, state, zip
<br />Washington, D.C. 20531.
<br />code)
<br />As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
<br />1. Grantee Name and Address:
<br />2. Application Number and/or Project Name
<br />3. Grantee IRSNendor Number
<br />4. Typed Name and Title of Authorized Representative
<br />5. Signature
<br />6. Date
<br />-U.S. Government Printing Office: 1996 - 405-037/40014
<br />
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