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Drug Testing Program
(printable copy)

DRUG CONSORTIUM APPLICATION 2010

You must be a member of a maritime organization (LECBA, West Sister, etc).  Send a copy of your current random drug testing card with your application. If you do not have one you will have to pre-employ at your expence. Call (419) 734-2670 if you need an application. 

CAPTAIN___________ MATE_________

NAME_______________________________________

ADDRESS ___________________________________

CITY_________________________________________

STATE__________________ ZIP______________

EMAIL_______________________________________

HOME PHONE NUMBER_______________________

CELL PHONE NUMBER_________________________

DATE OF BIRTH________________________

SOCIAL SECURITY NUMBER__________________

USCG LICENSE # ____________________________

EXPIRATION DATE_____________

Are you currently a member of a maritime drug consortium?

Yes ______ No________

OH or Documentation #’s________________________

SIGN ________________________________________

DATE ________________

$ 45. DUES ARE EFFECTIVE
JANUARY 1 to DECEMBER 31 of current year

Make checks payable to LECBA Drug Program

mail to:
LECBA Drug Program
c/o Sandee Abele
245 N Worthy
Lakeside, OH 43440


Questions call Sandee Abele

(419) 732-2670

email: saja@cros.net

 

 

LECBA NEWS

LECBA SUMMER BASH

Aug 21 2010 @ The Pond

Contact Pete Schide for more info

(419)656-0883

Next board meeting

Aug 9 2010

The Pond @ 6PM

Governors Day

July 12, 2010

 

 

 

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