RES 127 Draft 01 2010-2012 - Laserfiche WebLink

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(1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal crug statute occurring in the workplace no later than five calendar days after such conviction; (e) Notifying the agency, in writing, within 10 calendar days afftter receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such convic- tion. Employers of convicted employees must provide notice, including position title to: Department of Justice, Office of Justice Programs, ATTN: Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 20531. Notice shall include the iden- tification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is sc convicted - (1) Taking appropriate personnel action against such an employee, up to and including termination consistent with the requirements of the Rehabilitafion Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a druo abuse assistance or rehabilitation program approved for sucli purposes by a Federal, State, or local health, law enforce- ment, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug- free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f). B. The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant: Place of Performance (Street address, city, country, state, zip code) Check ❑ if there are workplace on file that are not identified here. Section 67, 630 of the regulations provides that a grantee that is a State may elect to make one certification in each Federal fiscal year. A copy of which should be included with each ap- plication for Department of Justice funding. States and State agencies may elect to use OJP Form 4061/7. Check ❑ if the State has elected to complete OJP Form 4061/7. DRUG -FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67; Sections 67.615 and 67.620 - A. As a condition of the grant I certify that I will not engage in the unlawful manufacture, distribution, dispensing; posses- sion, or use of a controlled substance in condition any activity with the grant; and B. If convinced of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to: Department of Justice, Office of Justice Programs, ATTN. Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 20531. As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications. Harry S. Kubojiri 1. Grantee Name and Address: Police Chief Hawaii County Police Department 349 Kapiolani St. Hilo, HI 96720 2. Application Number and /or Project Name 3. Grantee IRSNendor Number 4. Typed Name and Title of Authorized Representative 5. Signature JUL 2 7 2011 6. Date