Land, Sea and Air Sponsorship Agreement for
Education and Rehabilitation

1. I understand that it is my responsibility to follow the education/rehabilitation process as designated by the agency of the Department of Transportation for which I am affected (and any additional medical certification requirements of that agency), in order to resume a Safety Sensitive Position.
2. All costs will be my responsibility.
3. I am to report to the assigned collection site expeditiously when I am called for a follow-up unannounced drug test on the day I am notified by telephone or by my company's DER. .
4. If I fail to appear for a follow-up test on the day I am notified by Land, Sea and Air, I could be required to repeat the entire education/rehabilitation process if the MRO Dr. Panzer, determines that there is no legitimate excuse for missing the test.  I understand that I will be subject to any penalties, stipulations and requirements of the agency of the DOT of which I am covered.
5. A voucher will be sent to the collection site requesting a follow-up test. The collection site will note the time and date you reported for the test and the voucher will be returned to Land, Sea and Air Medical Review.
6. You are responsible for providing an up to date address, and telephone number where you can be contacted. We must be notified of any changes immediately.
7. Fee Structure:

A one time fee of $220.00 will establish you in an education/rehabilitation program, this includes:

1. Referral to a Substance Abuse Professional
2. Managing your Rehabilitation
3. MRO Services
4. Clearing you to return to your Safety Sensitive Position
5. Payment of last Follow-up Drug Screen

This payment is due prior to your starting the education/rehabilitation process.
After you have completed your rehabilitation program you will be placed on an unannounced follow-up testing program, which will continue once you are hired into a safety sensitive position. You will be required to complete a minimum of 6 follow-up drug screens, depending on the SAP's recommendations.  All tests should be spread out evenly throughout the year.  The cost of each of these Drug Screens will be $70.00 excluding your last Drug Screen.

8. The site where the collections are performed may charge a collection fee. You are responsible for this fee.
9. You will be able to apply for a Safety Sensitive Position once you have:

• Complied with the recommendations of the substance abuse professional
• Passed a Return to Duty Drug Test and complied with any requirements or regulations of the Agency of the DOT for which you are covered.
• Signed a release if you wish to have our MRO, Dr. Panzer send your Drug Test, and/or Alcohol Test results to your new employer.

If you have any questions you can contact us at (631) 225-3060 or visit our website at www.lsamr.com and e-mail us.