I have read and understand the conditions for acceptance into the Commercial Truck Driving Program. I understand that any misleading or false information in my application or interview(s) may result in my termination from the program (see preregistration and Withdrawal/Drop policy). I agree to finish all of the items listed below as scheduled:

• Take a UCC Compass test at least one week prior to the start of the course
• Obtain a DOT physical Examination at least two weeks prior to the start of the course
• Obtain an Oregon Class A driving permit. Must hold a Class B or C driver license an have had the license for at least one year
• Obtain a DOT drug screen one week prior to the start of the class you will be attending

I have no physical restrictions or limitations that would interfere with my ability to prepare for the Commercial Driver License Exam or that would restrict my opportunities for employment as a professional truck driver.

Federal regulations require Commercial Truck Driving Programs in public schools to participate in DOT drug screening. The statute requires that all persons driving a commercial vehicle, whether licensed / permit or employed / student, must pass a DOT drug screening and be subjected to random drug and alcohol testing during their training or employment.

Under this regulation, all applicants to the Umpqua Community College Truck Driving Program will be required to pass a DOT (Pre-employment) drug screen within 30 days before starting the training, and be prepared for random testing during the road training period.

Applicants may obtain their drug screening at:

Evergreen Family Medicine
OccuHealth
2570 NW Edenbower Blvd
Roseburg, OR 97470
Phone: 541-677-7477

The cost of a DOT (pre-employment) drug screen is about $60.00 (subject to change without notice) The cost of the DOT physical is about $110 (subject to change without notice)

Patients must present photo ID and let the receptionist know you are there for the UCC Commercial Truck Driving Program. You will be asked to sign a “Patient Authorization for release of Confidential Drug Screening and/or Alcohol Testing Information and Records” form. This gives the clinic authorization to release the test results directly to UCC. If you have any questions, please contact EFN (OccuHealth) at 541-679-2273.

Our office will be notified of your results and you can get a copy from UCC Commercial Truck Driving Program Coordinator. We will notify you if there is a problem with the drug screen. EFM is qualified to do DOT physicals; you will need to schedule an appointment for the physical. Do not have the drug screen until you have been approved by the CDL program coordinator and your funding agency (if you have one). Physical can be scheduled at any time and must be completed before a CDL permit can be issued by DMV. Drug screen should be completed 5 – 10 days prior to the start of class.

I hereby authorize Umpqua Community College, its District, Board of Education and its employees (UCC), or persons hired by UCC to photograph, record, tape, film or electronically capture in permanent from my name, likeness, image, voice, biographical and personal information, appearance and/or performance, and/or further to use and publish my writing(s) (collective work). I further grant UCC full permission to edit my writings and the original footage, data, voice or image as shall be deemed necessary; that the work and my name may be used, published and distributed without remuneration to me in who or in part for educational, instructional or promotional purposes in print or over open broadcast, cable, audio-visual, radio, closed-circuit exhibition, computer like, or other medium for college purposes as deemed appropriate by UCC in perpetuity, throughout the world.

For these purposes, I waive and relinquish my personal rights, privacy rights and rights under the Family Education Rights, Privacy Act and student record law of the state of Oregon. I hereby waive all right to any claim for royalties or other payments. Said work and all components thereof shall become the property of UCC and maybe be copyrighted in its own name or a name of its choosing.

I also release UCC from any and all claims of libel, slander, invasion of privacy or other claims based on my appearance and/or performance of use of the recording of such and agree to hold UCC harmless from any and all claims by the Third Parties, including any claim based on allegation of copyright infringement from my appearance and/or performance.