This form is for companies wishing to enroll in the Random Enlistment Program (Consortium). Once a form is received, a Valley Day and Night Clinic representative will contact the Designated Employer Representative (DER) within 5 business days. If you have any questions, please contact Charlie Canizales at email@example.com or by phone at (956)589-7156.
***Employee representative is responsible to immediately inform Valley Day & Night Clinic if an employee is not active with the company or if a new employee needs to be added to the driver list. If employer does not comply company will be removed from Random Program and will need to
register again, registration fees will reapply no exceptions.
Random Enlistment Fee $150.00 Yearly
DOT Drug Test $50.00 Per Drug Test
DOT Breath Alcohol Test $30.00 Per BAT