<%@ Page Title="" Language="vb" AutoEventWireup="false" MasterPageFile="Application.master" CodeBehind="ControlledSubstances.aspx.vb" Inherits="Web.ControlledSubstances" %>
<%@ MasterType VirtualPath="Application.Master" %>
<%@ Register TagPrefix="ctrl" Namespace="Web" Assembly="Web" %>
<%@ Register Src="~/_include/controls/Signature.ascx" TagPrefix="ctrl" TagName="Signature" %>
<%@ Register Src="~/_include/controls/YesNoPicker.ascx" TagPrefix="ctrl" TagName="YesNoPicker" %>
<asp:Content ID="Content1" ContentPlaceHolderID="phContent" runat="server">

    <h1>Previous Pre-Employment Controlled Substances or Alcohol Test Disclosure</h1>

    <section>

        <p>The following question is made necessary for employment with <span class="autofilled"><%= Master.app.clientName %></span> by the Federal Motor Carrier Regulations, Section 40.25.</p>

        <ul class="formFields">
            <li>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="ynTestPositive"
                    Text="required" Display="Dynamic" CssClass="required" />
                <asp:Label runat="server" AssociatedControlID="ynTestPositive"
                    CssClass="long"
                    Text="Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two (2) years?" />
                <ctrl:YesNoPicker ID="ynTestPositive" runat="server" />
            </li>
        </ul>

        <div class="dependent"
            data-dependency="<%= ynTestPositive.ClientID %>"
            data-value="true">

            <p>If yes, please provide the name of the Substance Abuse Professional (SAP) that evaluated you below, along with the name of the agency that performed your return to duty test.</p>
            <ul class="formFields">
                <li class="big left">
                    <ctrl:RequiredDependentFieldValidator runat="server" ControlToValidate="txtProfessional"
                        DependencyControl="ynTestPositive" WhenValue="true"
                        Text="required" Display="Dynamic" CssClass="required" />
                    <asp:Label runat="server" AssociatedControlID="txtProfessional"
                        Text="Substance Abuse Professional" />
                    <asp:TextBox ID="txtProfessional" runat="server"
                        MaxLength="128" />
                </li>
                <li class="right">
                    <ctrl:RequiredDependentFieldValidator runat="server" ControlToValidate="txtProfessionalPhone"
                        DependencyControl="ynTestPositive" WhenValue="true"
                        Text="required" Display="Dynamic" CssClass="required" />
                    <asp:Label runat="server" AssociatedControlID="txtProfessionalPhone"
                        Text="Phone" />
                    <asp:TextBox ID="txtProfessionalPhone" runat="server"
                        MaxLength="50" TextMode="Phone" />
                </li>
                <li>
                    <ctrl:RequiredDependentFieldValidator runat="server" ControlToValidate="txtReturnToDutyTest"
                        DependencyControl="ynTestPositive" WhenValue="true"
                        Text="required" Display="Dynamic" CssClass="required" />
                    <asp:Label runat="server" AssociatedControlID="txtReturnToDutyTest"
                        Text="Return to Duty Test Agency" />
                    <asp:TextBox ID="txtReturnToDutyTest" runat="server"
                        MaxLength="128" />
                </li>
            </ul>

            <p><em>If you answered yes to the above question please request Consent for Release of Information regarding Previous Pre-
    Employment Controlled Substances or Alcohol Testing form.</em></p>

        </div>

        <ctrl:Signature ID="signature" runat="server" ContextId="applicationroot" />

    </section>

</asp:Content>
