Can this be signed electronically?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA in the states that adopted it. Ensure intent, consent, attribution, and record retention to meet the four-part legal test for a valid e‑signature.

When is notarization required?

Notarization depends on corporate bylaws, the nature of the declaration, or state law. If bylaws or a third party require acknowledgment, follow state notary rules or RON procedures where permitted.

What if the signer made an error?

Minor clerical errors should be corrected by a dated amendment or by reissuing the statement with an explanatory note; material changes may require a new signed statement and legal review.

Who must retain the record?

The corporate secretary or designated records custodian should retain the authoritative original; HR may keep a copy in the personnel file to ensure access for audits and investigations.

How long must I keep it?

Follow applicable federal and industry retention rules: IRS-related records 3 years (IRC §6501(a)), HIPAA 6 years (45 CFR §164.530(j)), and longer if state law requires it.

Can the statement be revoked?

A statement that contains attestations may be superseded by a later signed statement. Revocation or correction should be documented in writing and retained with the original record.

Electronic Signature
Templates
HR
Employee Directors Statement

Employee Directors Statement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYEE DIRECTORS STATEMENT

Personal Information

Full Legal Name Home Address

Telephone

Email

Position Information

Proposed / Current Job Title Department

Reporting Manager: Start Date (anticipated or actual):

Base Salary / Compensation

Employment History (most recent first)

Employer 1 — Company Name

Primary Responsibilities Reason for Leaving Employer 2 — Company Name

Primary Responsibilities Reason for Leaving

Education

Highest Degree Institution Graduation Date

Professional References (3)

Reference 1 Reference 2 Reference 3

Legal Disclosures & Director Obligations

At-Will Employment: I understand that, unless otherwise expressly provided in a separate written agreement signed by an authorized company representative, my employment is at-will and may be terminated by either the company or me at any time, with or without cause or notice.

Equal Opportunity: The company provides equal employment opportunity without regard to protected characteristics. I acknowledge that I have read and received the company’s equal employment policy and will comply with all nondiscrimination requirements.

Director Duties: As an employee serving in a director capacity or with director-level responsibilities I acknowledge the duties of loyalty, confidentiality, and care owed to the company. I will disclose conflicts of interest, avoid unauthorized personal benefit from transactions with the company, and comply with the company’s insider trading and related-party transaction policies.

Have you ever been convicted of a felony or misdemeanor related to your professional activities? Yes No

Have you ever been the subject of regulatory or licensing sanctions, civil penalties, or professional discipline? Yes No

Do you currently hold any outside directorships, significant ownership interests, or other roles that could present a conflict? Yes No

Authorizations and Certifications

Authorization to Contact and Background Checks: I authorize the company and its agents to contact my current and former employers, educational institutions, licensing boards, and references to verify information provided on this statement and to obtain background checks as necessary for employment and director appointment decisions.

Consent to Background Check I consent I do not consent

Applicant Certification: I certify that the information contained in this Employee Directors Statement is true, complete, and correct to the best of my knowledge. I understand that any material misstatement, omission, or falsification may result in rejection of my application for appointment, or if appointed, termination of employment or removal from a director role. I further acknowledge my continuing duty to disclose any material change to the information provided herein.

Additional Comments or Disclosures

Printed Name:

Signature:

Date:

What the Employee Directors Statement Is and When It’s Used

An Employee Directors Statement is a written declaration an individual provides to confirm their status, role, or actions related to a corporate board or directorship while employed. Typical uses include disclosures for conflicts of interest, confirmatory statements for internal corporate records, attestations required for regulatory compliance, and documentation when an employee serves concurrently as a company director. The statement is usually signed by the employee, dated, and may require a corporate witness or notarization depending on corporate bylaws or state law. Electronic execution is generally acceptable under U.S. e-signature law when the record meets legal validity requirements.

Why a Clear Employee Directors Statement Matters

A concise, well-completed statement reduces governance risk, documents potential conflicts, and creates an auditable record for HR and legal teams. Properly executed statements help organizations satisfy internal governance, board oversight, and external compliance obligations.

Who Typically Prepares and Reviews This Statement

HR, corporate secretaries, general counsel, and board administration teams prepare, request, and review Employee Directors Statements to confirm role alignment and compliance.

Board administration and corporate secretaries — ensure the statement meets bylaws and recordkeeping standards.
HR and compliance teams — collect and store statements for conflict-of-interest screening and personnel files.
Employees serving as directors — complete and certify the statement for accuracy and signature.

Final review usually sits with legal or the corporate secretary before the document becomes part of the official corporate record.

Who Can Sign and What Their Role Is

Employee / Director

The primary signer is the employee who is also a director or whose director status is under declaration. Their signature attests to facts in the statement and creates a record of intent and attribution under ESIGN/UETA standards.

Corporate Secretary

A corporate secretary or authorized officer may countersign, acknowledge, or file the statement on the company record; in some jurisdictions the secretary’s acknowledgment supports internal governance and may be required by bylaws.

Key Components to Include in a Professional Statement

A complete Employee Directors Statement combines identifying details, a clear declaration of directorship or conflict disclosures, a dated signature block, and any required acknowledgments or attachments.

Identification

Full legal name, employee ID, and title so the record clearly ties to the individual and payroll or HR systems.

Statement Body

A concise declaration of directorship status, dates of service, and any concurrent roles that could create conflicts of interest.

Conflict Disclosure

Itemized conflicts or related-party relationships with dates and descriptions, enabling compliance review.

Dates

Effective date and, if applicable, end date of directorship or the period covered by the statement.

Signature

Signed and dated by the employee; include printed name and title to ensure attribution and intent.

Acknowledgment

Countersignature, corporate stamp, notary block, or witness section if bylaws or state law require formal acknowledgment.

Step-by-Step: Completing an Employee Directors Statement

Follow these steps to prepare, validate, and file the statement so it meets corporate and legal expectations.

01

Gather Details: Collect name, title, board name, and service dates.
02

Draft Declaration: Write a concise, factual statement of directorship and any disclosures.
03

Sign and Date: Employee signs; include printed name and MM/DD/YYYY date.
04

File Record: Submit to corporate secretary or upload to central records.

How to Configure an Online Completion Workflow

Set up a repeatable digital workflow so statements are consistently completed, approved, and stored.

Field	Configuration
Required Fields	Make name, date, declaration, signature mandatory
Signer Order	Employee first, corporate secretary second
Authentication	Use email link or SMS code for signer verification
Archive	Save signed PDF + audit trail to records system

Where to Send or File the Completed Statement

Decide a single authoritative destination for the finished statement to avoid fragmentation of records.

Corporate Secretary: Maintain original in corporate records repository
HR Personnel File: Store a copy linked to the employee’s HR record
Legal Department: Retain for compliance and conflict review
Document Archive: Upload signed PDF and audit trail to secure storage

Options for Digital Signing and Distribution

Choose a platform that supports secure e‑signatures, audit trails, and integration with your records system.

Format Support: PDF and DOCX compatibility
Authentication: Email, SMS, or advanced signer verification
Integrations: Connectors for HR and document management

Ensure selected tools meet retention, access control, and any regulatory privacy requirements before rollout; coordinate with IT and legal.

Timing Considerations and Internal Deadlines

Establish clear internal deadlines so statements are collected promptly after appointment or when a material change occurs.

Initial Submission Deadline:

Within 30 days of accepting directorship

Annual Reaffirmation:

Collect updated statements once per fiscal year

Material Change:

Within 10 business days of a material change

Board Record Filing:

File with minutes within the same reporting cycle

Retention Start Date:

Retention begins on the statement date

Key Milestones in the Statement Process

Track sequential milestones from request to archival to maintain an auditable chain of custody.

01

Request Issued

HR or corporate secretary issues the request and checklist.

02

Employee Completion

Employee fills and signs the statement.

03

Legal Review

Legal reviews disclosures and advises on conflicts.

04

Archival

Signed copy and audit trail are archived securely.

Common Preparation Mistakes to Avoid

Leaving dates in ambiguous formats — always use MM/DD/YYYY to avoid administrative confusion and retention errors.
Omitting a clear description of related-party relationships, which can impede conflict-of-interest assessments.
Failing to include an explicit signature and printed name, reducing the statement’s evidentiary value for audits.
Storing copies in multiple uncontrolled locations, which complicates retrieval and legal preservation obligations.

Risks from Incomplete or Incorrect Statements

Governance Risk: Delayed or inaccurate disclosures

Regulatory Exposure: Noncompliance with oversight obligations

Contractual Risk: Conflicting duties not documented

Employment Action Impact: Disciplinary ambiguity

Recordkeeping Gaps: Audit failures

Reputation Harm: Stakeholder trust erosion

Essential Data Elements to Capture

Director's Name: Full legal name

Employee ID: Internal personnel identifier

Position Title: Official corporate title

Statement Date: MM/DD/YYYY

Signature: Signed and dated

Acknowledgment: Notary or witness info

How Organizations Use Signed Director Declarations

These examples show practical applications of an Employee Directors Statement in business operations and governance.

Tech Data — Internal Records

Tech Data standardized signatures for internal governance using an e-sign platform to reduce turnaround time.

Used central templates for uniform disclosures.
The approach reduced administrative friction and helped legal and HR maintain a single authoritative copy tied to personnel records and audit trails.

Fertility Centers of Illinois — Compliance

A healthcare provider moved director attestations online to maintain secure, auditable records.

Implemented additional privacy controls for sensitive attachments.
This improved retrieval for audits and aligned retention with HIPAA obligations while preserving proof of intent and signer attribution.

eSignature Vendor Pricing and Feature Snapshot

Compare starting price and key features relevant to executing Employee Directors Statements; signNow appears first per vendor ordering requirements.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Common Questions About Employee Directors Statements

Answers address legal validity, execution options, corrections, and retention to help teams avoid common pitfalls when creating or signing the statement.

Need help? Contact support

Can this be signed electronically?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA in the states that adopted it. Ensure intent, consent, attribution, and record retention to meet the four-part legal test for a valid e‑signature.
When is notarization required?
Notarization depends on corporate bylaws, the nature of the declaration, or state law. If bylaws or a third party require acknowledgment, follow state notary rules or RON procedures where permitted.
What if the signer made an error?
Minor clerical errors should be corrected by a dated amendment or by reissuing the statement with an explanatory note; material changes may require a new signed statement and legal review.
Who must retain the record?
The corporate secretary or designated records custodian should retain the authoritative original; HR may keep a copy in the personnel file to ensure access for audits and investigations.
How long must I keep it?
Follow applicable federal and industry retention rules: IRS-related records 3 years (IRC §6501(a)), HIPAA 6 years (45 CFR §164.530(j)), and longer if state law requires it.
Can the statement be revoked?
A statement that contains attestations may be superseded by a later signed statement. Revocation or correction should be documented in writing and retained with the original record.

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