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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 />(e) Notifying the agency, in writing, within 10 calendar days <br />after receiving notice under subparagraph (d)(2) from an <br />employee or otherwise receiving actual notice of such conviction. <br />Employers of convicted employees must provide notice, including <br />position title, to: Depanment of Justice, Office of <br />Justice Programs, ATTN: Control Desk, 633 Indiana Avenue, <br />N.W., Washington, D.C. 20531. Notice shall include the iden- <br />tifcation number(s) of each affected grant; <br />(f) Taking one of the following actions, within 30 calendar <br />days of receiving notice under subparagraph (d)(2), with <br />respect to any employee who is so convicted- <br />(1)Taking appropriate personnel action against such an <br />employee, up to and including termination, consistent with the <br />requirements of the Rehabilitation Act of 1973, as amended; or <br />(2) Requiring such employee to participate satisfactorily in a <br />drug abuse assistance or rehabilitation program approved for <br />such purposes by a Federal, State, or local health, law enforce- <br />ment, or other appropriate agency; <br />(g) Making a good faith effort to continue to maintain adrug- <br />lree workplace through implementation of paragraphs (a), (b), <br />(c), (d), (e), and (f). <br />B. The grantee may insert in the space provided below the <br />site(s) for the performance of work done in connection with <br />the specific grant: <br />Place of Performance (Street address, city, county, state, zip <br />code) <br />Check ^ if there are workplaces on file that are not indentified <br />here. <br />Section 67, 630 of the regulations provides that a grantee that <br />is a Stale may elect to make one certification in each Federal <br />fiscal year. A copy of which should be included with each ap- <br />plication for Department of Justice funding. States and State <br />agencies may elect to use OJP Form 4061/7. <br />Check ~ if the State has elected to complete OJP Form <br />aosln. <br />DRUG•FREE WORKPLACE <br />(GRANTEES WHO ARE INDIVIDUALS) <br />As required by the Drug-Free Workplace Act of 1988, and <br />implemented at 28 CFR Part 67, Subpan F, for grantees, as <br />defined at 28 CFR Part fi7; Sections 67.615 and 67.620- <br />A. As a condition of the grant, I certify that 1 will not engage <br />in the unlawful manufacture, distribution, dispensing, posses- <br />sion, or use of a controlled substance in conducting any <br />activity with the grant; and <br />B. If convicted of a criminal drug offense resulting from a <br />violation occurring during the conduct of any grant activity, I <br />will report the conviction, in writing, within 10 calendar days <br />of the conviction, to: Department of Justice, Office of Justice <br />Programs, ATTN: Control Desk, 810 Seventh Street NW., <br />Washington, DC 20531. <br />As the tluly 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 3. Grantee IRSNendor Number <br />4. Typed Name and Title of Authorized Representative <br />5. Signature 6. Date <br />vs. co.emmem admmq ogee: rasa- aos-osnaoora <br />