Employee Individual Waiver

EMPLOYEE INDIVIDUAL WAIVER

Parties and Effective Date

Employer Name:

Employee Name:

Effective Date:

Purpose and Recitals

This Employee Individual Waiver (the "Waiver") documents the understanding and agreement between Employer and Employee regarding the voluntary participation by the Employee in certain activities, programs, or assignments that are not part of the Employee's regular job duties. Employee hereby acknowledges that participation is voluntary and that certain risks may be inherent in such participation.

Personal Information

Position Information

Voluntary Activity or Assignment

Description of voluntary activity, program, or assignment (location, nature, expected duration):

Waiver, Release, and Assumption of Risk

In consideration of the Employee's voluntary participation in the activity described above, Employee knowingly and voluntarily agrees as follows:

1. Waiver and Release: Employee releases, waives, and forever discharges Employer and its officers, directors, employees, agents, successors and assigns from any and all claims, demands, causes of action, damages, liabilities or expenses, whether known or unknown, that arise out of or relate to Employee's participation in the activity, including but not limited to claims for bodily injury, property damage, emotional distress, or economic loss, except for claims resulting from Employer's gross negligence or willful misconduct.

2. Assumption of Risk: Employee acknowledges the potential for injury or loss associated with participation and expressly assumes all risks, whether foreseeable or unforeseeable, arising from such participation.

3. Indemnification: To the fullest extent permitted by law, Employee agrees to indemnify, defend and hold Employer harmless from and against any claims, losses, damages, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of Employee's acts or omissions in connection with participation in the activity.

4. Workers' Compensation: This Waiver is not intended to, and shall not, eliminate or diminish any rights Employee may have under applicable workers' compensation laws for claims that are compensable under those laws. Nothing in this Waiver shall be construed to waive statutory workers' compensation benefits to which Employee is entitled for covered workplace injuries.

Acknowledgements and Certifications

Employee certifies that Employee is physically able to participate in the activity and has not been advised otherwise by a qualified medical professional. Employee agrees to follow all reasonable safety instructions provided by Employer and its representatives.

Employee acknowledges that execution of this Waiver is a condition of participating in the activity and that Employee has had the opportunity to ask questions and obtain clarification regarding the risks, rewards and conditions of participation.

I have read and understand the Waiver, Release, Assumption of Risk and Indemnification provisions and accept them.

Authorization to Contact and Background Checks

Employee hereby authorizes Employer and its designated representatives to contact previous employers, educational institutions, personal references, and other sources to verify information provided by Employee and to perform background checks, including criminal history, driving records, and credit history where permitted by law.

By checking the box below, Employee consents to the release of such information to Employer and acknowledges that false statements or omissions may be grounds for discipline, up to and including termination.

I authorize Employer to conduct background checks and contact prior employers and educational institutions as described above.

Employment History

Education

References

Legal Notices

At-Will Employment: Nothing in this Waiver is intended to alter the at-will nature of employment, unless otherwise expressly stated in a separate written agreement signed by an authorized representative of Employer. Either Employer or Employee may terminate the employment relationship at any time, with or without cause or notice, subject to applicable law.

Equal Employment Opportunity: Employer is an equal opportunity employer. Employer does not discriminate on the basis of any protected characteristic and will make reasonable accommodations as required by law.

Miscellaneous Provisions

Severability: If any provision of this Waiver is held to be invalid or unenforceable, the remainder of this Waiver will remain in full force and effect.

Governing Law: This Waiver shall be governed by and construed in accordance with the laws of the state in which Employer maintains its principal place of business, without regard to conflict of law principles.

Entire Agreement: This Waiver constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior or contemporaneous oral or written agreements concerning the same.

Applicant Certification

I certify that all information provided in this Waiver and accompanying sections is true and complete to the best of my knowledge. I understand that making false statements may result in disciplinary action, including termination. I acknowledge that I have read and understand this Waiver, that I have had the opportunity to ask questions, and that I sign this document voluntarily.

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