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  2. Forms Repository
  3. UCB-18102-E

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Development, Unemployment Insurance (DWD/UI) of a conditional offer of work that required a drug test and the offer was rescinded due to: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.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

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