Employee Card Key Renewal Agreement

EMPLOYEE CARD KEY RENEWAL AGREEMENT

This Employee Card Key Renewal Agreement documents the request, approval, and conditions for issuing or renewing an access card (hereafter "Card") to the Employee identified below. The Employee acknowledges receipt of the Card is subject to the security, disciplinary, and return provisions set forth in this Agreement.

Personal Information

Position Information

Current Start Date of Employment:   Current Salary (annual):

Card Key Details — Renewal Request

Date of Card Issuance:   Requested Renewal Date:

Renewal Reason: Lost Damaged Malfunction Expired Change in access privileges

Payroll Deduction Authorization for Fee? Yes No

Security, Use and Return Obligations

1. Employee acknowledges the Card remains the property of the Employer and is issued solely for authorized business access. Unauthorized sharing, duplication, modification, or use of the Card for non-business purposes is strictly prohibited and may result in disciplinary action, civil liability, or criminal prosecution.

2. Employee agrees to keep the Card secure at all times. Lost or stolen Cards must be reported immediately to Security and the Reporting Manager. Failure to report loss or misuse promptly may result in sanctions.

3. Employee shall surrender the Card upon request by the Employer, upon termination of employment, change in position, or reassignment of access privileges. Employer may deactivate access without prior notice when security is reasonably at risk.

4. The Employee is financially responsible for replacement fees resulting from negligence or misuse as determined by Employer policy.

Authorization and Approvals

I authorize the issuance or renewal of a Card subject to the terms of this Agreement. I understand access granted may be limited by schedule, area, or role and may be revoked at Employer discretion for cause or for reasons of facility security.

Manager Approval Signature:   Date:

Employment History

Employer 1

Dates Employed: From to

Employer 2

Dates Employed: From to

Education

Graduation Date:

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-Will Employment: If applicable to jurisdiction and role, Employee acknowledges that employment is at-will and may be terminated at any time by either party, with or without cause, except where modified by a separate written agreement signed by authorized representatives of the Employer.

Equal Employment Opportunity: Employer provides equal opportunity to all employees and applicants without regard to protected characteristics. Card issuance and access privileges are administered without unlawful discrimination.

Authorization to Contact and Background Checks

By signing below, Employee authorizes Employer to contact previous employers, references, and other entities for the purpose of verifying the information contained in this form and for conducting any background, personnel, or security checks required for issuance of the Card. Consent is conditioned on compliance with applicable laws.

Employee Consent to Background Check: I consent    Initials:

Applicant Certification

I certify that all information provided in this Card Key Renewal Agreement is true, correct, and complete to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may result in denial of issuance, disciplinary action, or termination of employment. By signing below I accept the obligations, fees, and policies stated in this Agreement.

Consent to Terms: I agree to the terms and conditions above

Acknowledgment of Receipt (To be completed by Security)

Card Issued / Renewed: Issued Not Issued

Security Notes:

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