Roebbelen Contracting, Inc.

AT&T Drug Testing Policy

TO:

All AT&T Alliance Subcontractors

RE:

Drug Testing and Background Check Policy AT&T

As of November 1, 2000, AT&T now requires that if the nature of your work requires unescorted
access to AT&T facilities the following new procedures will apply:
You must be issued a AT&T badge along with a photo ID card issued by Roebbelen.
A one time background check of all new personnel which includes:
Social Security Number Trace
Felony Criminal Record Check Conducted by search of court records in counties of
residence and employment for the previous seven years.
No ID badge will be issued to personnel that do not pass social security trace or who have a
felony conviction in the last seven years.
A one time urine drug test which will be tested by an Enzyme Multiplied Immunoassay, or
equivalent drug test is required that screens for:
Amphetamines
Cocaine
Marijuana
Opiates
Phencyclidine (PCP)
Methadone
Methaqualone
Propoxyphene
Benzodiazephines
Barbiturates
No ID badge will be issued for any personnel who fails the drug test.
This new policy/procedure will work as follows:
A new employee (who has never had a AT&T ID badge) will fill out the following forms:

Consent Form for Drug Testing and Background Check (attached) It is imperative that
both consent forms be filled out fully. Failure to fill either the application or the consent
form completely will hold up the badge process.

Once those have been completed, forward the forms along with a digital photo via email
or on disk to Dana Lahargoue. This can either be done by mail to Roebbelen, 1241
Hawks Flight Ct., El Dorado Hills, CA 95762 or by fax to (916) 939-1143. Digital
photos may be emailed to Kathie Garrison at kathieg@roebbelen.com, but dont forget to
fax or mail the application to Dana Lahargoue. Digital photos must have a white
background and subject must not be wearing a hat or glasses. Should you not have a
digital camera you may go to any of the Roebbelen jobsite personnel and have a photo
taken there.
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AT&T Drug Testing Policy

It is very important these forms be faxed immediately. This is our check and
balance system. Should you not fax the consent forms, there is no way to
match when the drug test results are received. If the proper procedures are
not followed it will hold up the issuance of both the Roebbelen and AT&T
badges.

You then need to choose a clinic from the attached list. Send the new employee along
with the Treatment Authorization form (attached) for the drug test. The new employee
will also need a photo ID, ie drivers license, etc. It is imperative that the referral form
and photo ID is not forgotten. The clinic will not do any drug testing without the referral
form nor a photo ID.
Once the drug test results and background check have been received and the employee
has passed both, a AT&T and Roebbelen badge will be issued.
Should the employee fail either the drug test or the background check, the direct
supervisor listed on the consent form will be notified and badge application will then be
denied.
All documentation of the drug test results and background checks will be maintained in a
secure filing system in Roebbelens office.
Any person who has been issued a badge prior to November 1, 2000 will be exempt from
this new requirement.
All direct charges for the drug test and background check will be the responsibility of
Roebbelen.

Should you have any questions regarding the above procedures, please contact Dana Lahargoue
at 916-939-4000.

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AT&T Drug Testing Policy

CONSENT FOR URINE TEST FOR

DRUGS AND/OR ALCOHOL
I, (print name) ______________________________ understand that by requesting
( First, Middle, and Last Name )

a AT&T Badge, Roebbelen has adopted AT&Ts policy for drug testing and
criminal background checks. Since I am making a request for a AT&T
Identification Badge, I have been requested to give a urine specimen, which will
be tested by an Enzyme Multiplied Immunoassay, or equivalent drug test for the
following: Amphetamines, Cocaine, Marijuana, Opiates, Phencyclidine (PCP),
Methadone, Methaqualone, Propoxyphene, Benzodiazephines, Barbiturates and
Alcohol.
AT&T requires the AT&T job number and/or AT&T job address before approving
the badge request.
AT&T job# and location:__________________________________________
All charges for this urine test for drugs and or alcohol will be paid for by the
Company, and not me.
I have read, understand and agree to the above.
Date: ______________________ Time: _________________________
Employee Signature:_________________________________________
Company Name: ____________________________________________
Direct Supervisor: ___________________________________________
Direct Supervisor Phone Number: ______________________________
Job # & or Location: _______________________________________
For questions concerning the above, please contact Dana Lahargoue of
Roebbelen/Roebbelen Contracting, Inc. at (916) 939-4000.

Please fax completed form to Dana Lahargoue at (916) 939-1143.

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AT&T Drug Testing Policy

CONSENT FOR
CRIMINAL BACKGROUND CHECK
I, (print name) ________________________________________ understand that by requesting
( First, Middle, and Last Name )

an AT&T Badge, Roebbelen has adopted AT&Ts policy for drug testing and criminal
background checks. Since I am making a request for an AT&T Identification Badge, I hereby
volunteer the following information in order for a background check to be made which will
include: a) verification of social security number, and (b) felony criminal record check conducted
by search of court records in counties of residence and employment for the previous seven years.
AT&T requires the AT&T job number and/or AT&T job address before approving the badge
request.
AT&T Job # and address: _______________________________________________________
All charges for this background check will be paid for by the Company, and not me.
I have read, understand and agree to the above.
Date: ___________________________ Time: ____________________________
Company Name: ____________________________________________________
Employee Signature: _________________________________________________
Other Last Names Used:
__________________________________________________________________

Please print clearly:

Social Security #. _____________________Date of Birth______________________
MM/DD/YYYY
Address:
_____________________________________________________________________________
Length of Time at This Address: ________ If less than 7 years, please list previous address and
length of time at each address.
Other Address:

For questions concerning the above, please contact Dana Lahargoue of

Roebbelen/Roebbelen Contracting, Inc. at (916) 939-4000.

Please fax completed form to (916) 939-1143

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AT&T Drug Testing Policy

TREATMENT AUTHORIZATION
TAKE THIS FORM to CLINIC with PHOTO ID

Date: ________________________
Company Name :

ROEBBELEN CONTRACTING, INC.

Employee Name: __________________________________________

(please print legibly)
Employee Company Name: __________________________________
(please print legibly)

to receive the following:

SERVICES REQUESTED
10 Panel + Alcohol Pre-Employment Drug Screen

Authorized by:

DANA LAHARGOUE

Secure Fax No. 916-939-1143

Billing Address:

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Secure Voice Mail:

916-939-1150

Roebbelen Contracting, Inc.

1241 Hawks Flight Court
El Dorado Hills, California 95762
Attention: Dana Lahargoue
(916) 939-1150
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AT&T Drug Testing Policy

Oregon

Concentra Urgent Care

3108 NE 181st Ave.
Portland, OR 97230
503-253-5692
Concentra Tanasbourne
2225 NW Town Center Dr.
Beaverton, OR 97006
503-726-1021
Concentra Medical Center
6405 SW Rosewood St., Suite B
Lake Oswego, OR 97035
503-675-7603
Providence Occupational
9290 SE Sunnybrook Blvd., Suite 210
Clackamas, OR 97015
503-216-7960
Providence Occupational
18610 NW Corvell Rd. # 204
Hillsboro, OR 97124
503-216-0217

Providence Center for Occupational Medicine

1390 Biddle Rd., Suite 101
Medford, OR 97504
541-732-5554
Cascade Health Solutions
2650 Suzanne Way, Suite 200
Eugene, OR 97408
541-228-3000
Intermountain Mobile
541-963-0577
La Grande. OR

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AT&T Drug Testing Policy

Washington
US Healthworks Locations
Bellevue
1925 140th Ave. NE
Bellevue, WA 98005
Phone: (425) 865-8060
Federal Way
1300 South 320th St. #B
Federal Way, WA 98003
Phone: (253) 839-2727
Kent
24031 104th Ave. SE
Kent, WA 98030
Phone: (253) 852-1824
Lynnwood
4320 196th St. SW Suite D
Lynnwood, WA 98036
Phone: (425) 774-8758
Puyallup
3850 South Meridian
Puyallup, WA 98373
Phone: (253) 840-1840
Redmond
15937 Redmond Way
Redmond, WA 98052
Phone: (425) 882-0100
Seattle (Aurora)
836 NE Northgate Way
Seattle, WA 98125
Phone: (206) 784-0737
Seattle (Denny-Fairview)
1151 Denny Way
Seattle, WA 98109
Phone: (206) 682-7418

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US Healthworks Locations continued

Spokane (South Hill)

2005 E. 29th Ave
Spokane, WA 99203
Phone: (509) 747-0770
Spokane (North Side)
9222 North Newport Hwy. Suite 1
Spokane, WA 99218
Phone: (509) 467-4545
Spokane Valley
15425 East Mission
Spokane Valley, WA 99037
Phone: (509) 924-7010
Tacoma
2624 South 38th St.
Tacoma, WA 98409
Phone: (253) 475-5908
Tukwila
200 Andover Park East Suite 8
Tukwila, WA 98188
Phone: (206) 575-3136

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