Employee Employment Statement

EMPLOYEE EMPLOYMENT STATEMENT

Personal Information

Position Information

Job Title:    Department:

Reporting Manager:    Start Date:

Full-time    Part-time    Temporary    Contractor

Compensation:    Pay Frequency:    Exempt/Non-Exempt:

Employment History (Most Recent Two Employers)

Education

Graduation Date:

References (Professional)

Legal Disclosures and Statements

At-Will Employment: Employee acknowledges and agrees that, unless otherwise set forth in a signed, written employment agreement, employment with the Employer is at-will. Either the Employer or Employee may terminate the employment relationship at any time, with or without cause or advance notice. This statement may not be modified except in a writing signed by an authorized representative of the Employer.

Equal Opportunity Employer: The Employer prohibits discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to protected characteristics. Decisions regarding recruitment, hiring, promotion, discipline, compensation and termination shall be based on job-related criteria.

Authorizations, Certifications, and Acknowledgments

I certify that all information provided in this statement and any attached documentation is true, correct and complete to the best of my knowledge. I understand that any material misrepresentation, omission, or falsification may result in refusal to hire, or if employed, discipline up to and including termination.

Background and Reference Checks: I authorize the Employer to obtain information regarding my previous employment, education, criminal history where permitted by law, and other relevant background information. I authorize former employers and listed references to disclose my employment history and other pertinent information. I release such entities, the Employer, and their representatives from liability for furnishing this information in good faith.

Confidential Information and Proprietary Rights: Employee acknowledges that during employment Employee may have access to trade secrets and confidential information. Employee agrees to preserve confidentiality of employer information both during and after employment and to comply with any separate written confidentiality or proprietary information agreement executed by the parties.

Disability Accommodation: If you require a reasonable accommodation to perform the essential functions of the position, please notify Human Resources in writing so that the Employer may evaluate the request and, where required, engage in the interactive process to identify reasonable accommodations.

Applicant consents to background check and release of information by prior employers and educational institutions.

Additional Terms (If Applicable)

Probationary Period: Employee may be subject to an initial probationary or introductory period as specified by Employer policy. During such period, performance and fit will be assessed in accordance with Employer policies.

Benefits Eligibility: Eligibility for employer-sponsored benefits, including health insurance, retirement plans, and paid time off, is governed by plan documents and Employer policies. Eligibility dates and waiting periods shall be as set forth in those documents.

Acknowledgment of Receipt

I acknowledge that I have read and understand the statements above and that I have received a copy of this Employee Employment Statement when required by Employer policy.

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