My hubby's company is getting ready for their new yearly insurance crap... yeah it's crap... anyway this is a form we're required to sign........
tobacco Affidavit Please read the following statement in its entirety.
I hereby attest that I am "tobacco-free" and do not use any form of tobacco regardless of the frequency or method of use including cigarettes, pipes, cigars, and smokeless tobacco. If you are using Nicotine Replacement Therapy products (NRTs) including gum, lozenges and the patch, then you may attest that you are "Tobacco-free". You may not attest to being “Tobacco-free” if you use an Electronic Cigarette or “e-Cigarette.”
I understand that this affidavit may be provided to my employer. By submitting this form, I Consent to its disclosure.
I agree to the above statement.
I am using a Nicotine Replacement Therapy product
WTH!?!?
tobacco Affidavit Please read the following statement in its entirety.
I hereby attest that I am "tobacco-free" and do not use any form of tobacco regardless of the frequency or method of use including cigarettes, pipes, cigars, and smokeless tobacco. If you are using Nicotine Replacement Therapy products (NRTs) including gum, lozenges and the patch, then you may attest that you are "Tobacco-free". You may not attest to being “Tobacco-free” if you use an Electronic Cigarette or “e-Cigarette.”
I understand that this affidavit may be provided to my employer. By submitting this form, I Consent to its disclosure.
I agree to the above statement.
I am using a Nicotine Replacement Therapy product
WTH!?!?