Fill and Sign the Employee Dating Form

Acknowledgement and Waiver Regarding Employee Dating (One to be completed by each employee) Acknowledgement and Waiver made on the _____________________ (date) , by ____________________________ (Name of Male Employee) of _________________ ______________________________________________________________________ (street address, city, state, zip code) , referred to herein as Employee M , and _______________________ (Name of Female Employee) , of ___________________ ______________________________________________________________________ (street address, city, state, zip code) , referred to herein as Employee F , in favor of ____________________________ (Name of Company) , a corporation organized and existing under the laws of the state of ___________________, with its principal office located at _____________________________________________________________ ____________ (street address, city, state, zip code) , referred to herein as Company . Whereas, the undersigned acknowledges and agrees that it is unlawful and against the policy of Company, to require sexual favors as a condition of employment, with or without consent; and Whereas, a concern has been expressed by the Company regarding the personal relationship which has been entered into between Employee M and Employee F ; and Whereas, the Company on its behalf, as well as that of its employees, is concerned regarding any potential for legal exposure which may arise out of said relationship; and Whereas, Employee M and Employee F wish to provide assurances to the Company and its employees; Now, therefore, for and in consideration of their continued employment and in lieu of transfer, termination or other personnel action, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned __________________________ (Employee M or Employee F) agrees as follows: 1. As of the day of the signing of this agreement, I, _________________________ (Employee M or Employee F) , acknowledge a voluntary dating relationship with __________________________ (Employee M or Employee F) . 2. I have not requested, nor do I expect work-related favoritism from _________________________ (Employee M or Employee F) . 3. I am not aware of any work conflicts created by my dating relationship with ________________________ (Employee M or Employee F) . 4. As of the present date I am not aware of any conduct that I would consider to be wrongful on the part of _________________________ (Employee M or Employee F) , the Company or its employees, and I hereby waive any potential claim related to same; 5. Should at any time I consider the conduct of _________________________ (Employee M or Employee F) t o be unwanted, sexually hostile, or harassing, I will immediately inform the Company of same in writing. 6. I have entered into this agreement voluntarily. The terms of this agreement and its consequences have been completely read by me and I fully understand its terms. My execution of this agreement is free and voluntary. Witness my signature as of the _______ day and _______________, 20_____ (date) first above stated. __________________________ (Printed Name of Employee) __________________________ (Signature of Employee) State of _________________ County of ___________________ Personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within named ____________________ (Name of Employee) who, after having been first duly sworn, stated on oath that the matters and facts set forth in the above and foregoing Acknowledgement and Waiver are true and correct as therein stated. __________________________ (Printed Name of Employee) __________________________ (Signature of Employee) SWORN to and subscribed before me, this the _______ day of ________________, 20_____. __________________________________ Notary Public My Commission Expires: ___________________