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so2z.1 <br />Appendix 12c <br />ATTACfMEMIT C <br />CERTIFICATION RE6J1RgIMG DRUG-FREE MORKPLACE REQUIREHEN7S <br />1. Instructions for Certification <br />a. Dy subrltting this appticatian, the applicant is prod ding the <br />certification set out below. <br />b. The certification set out beta is a material representation of fact <br />upon Mhith reliance v111 be placed if NUD detar~ines !.o arwrd a <br />grant to the appltcant. If it is later deter'ined that the <br />appltcant knowingly rendered a false certification, or othe~D s;n <br />rriolates the requirements of the Drug-Free workplace Act, <br />aditake action auhthorixedaundervtheaDrug Freee orkplace~Kt~nt, <br />r <br />Z. Certification Re ardin Dru -Free Mork lace Re uirenents <br />a. The applicant certifies that 1t will proride a drug-free Mork Place <br />by: <br />1. Publishing a statement notifying employees that the unlareful <br />Manufacture. distribution, dispensation. ~rsntee~s wori~place a <br />controlled substance is prohibited to the g <br />am riolatlongof suchtprohibltion;ll be taken against eaPloyees <br />fo <br />2. Establishing a drug-free arareness prograa to informs e~loyees <br />about: <br />i. the dangers of drug abuse in the rorkplacr; <br />11. the applicant's politer of oaintaining a drug-free <br />•rori~pl ace: <br />1i1. any available drug counseling, rehabilitation, and <br />employee assistance progra~s; and <br />_. _ iv. abus~r~olationsaoccurringilnothe ~ np~eoyees for drug <br />~. }i{aking~ince ~~he 9ranttbetgiYen a~co y of theestatagementin the <br />__ perfo <br />required by paragraph i; <br />46 <br />6/90 12c-4 <br />