Pre-Employment Drug Testing - Employer Reported Refusal to Submit or Positive Test Result

Document Number: UCB-18102-E

Description: Use this form to notify the Department of Workforce Development, Unemployment Insurance (DWD/UI) of a conditional offer of work that required a drug test and the offer was rescinded due to:

  • the individual refusing to submit to a drug test for the unlawful use of controlled substances.
  • a positive drug test result for the unlawful use of a controlled substance.

Comments: This form can be filled out on the computer as a fillable pdf. It should be printed and signed, then mailed or faxed to Unemployment Insurance, P.O. Box 7905, Madison, WI 53707. The Fax Number is (608) 260-2506.

Content Contact: Benefit Operations Staff

Document Attachment: UCB-18102-E (Electronic Version - pdf/19 KB)

NOTE: When using Google Chrome, you may notice overlapping text when you select file, print. Deselect the 'fit to page' option and the text will no longer overlap.

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.