Employee Policy Acknowledgements

Employee Policy Acknowledgements

Personal Information

Position Information

Start Date:    Salary (annual):

Full-time    Part-time    Temporary/Contract

Employment History (Most Recent)

Dates Employed: From to

Employment History (Previous)

Dates Employed: From to

Education

Graduation Date:

References

Policy Acknowledgements (Read and Check)

Each of the following policies has been provided to me or made available to me. By checking the box and initialing, I acknowledge that I have received, read, understand, and agree to comply with the policy as applicable to my employment. I understand that violations may result in disciplinary action up to and including termination.

Code of Conduct — I acknowledge receipt and understand my obligations under the Code of Conduct.    Initials:

Confidentiality and Non‑Disclosure — I acknowledge my continuing obligation to protect company confidential information.    Initials:

Anti‑Harassment and Discrimination — I understand the prohibition against unlawful harassment and discrimination and the procedure for reporting complaints.    Initials:

Attendance and Punctuality — I acknowledge requirements for attendance, reporting absences, and timekeeping accuracy.    Initials:

Electronic Communications and Acceptable Use — I acknowledge rules governing use of company systems and data.    Initials:

Social Media and Public Communications — I understand expectations for public representation and social media conduct.    Initials:

Drug‑Free Workplace Policy — I acknowledge the company's drug and alcohol rules and testing policy.    Initials:

Health, Safety and Security — I acknowledge my duty to follow safety procedures and report hazards.    Initials:

Paid Time Off and Leave Policies — I acknowledge the company's PTO, sick leave and leave of absence policies.    Initials:

Remote Work / Telecommuting Policy — I acknowledge conditions for remote work, equipment use, and security.    Initials:

Conflicts of Interest — I understand the obligation to disclose actual or potential conflicts and to avoid actions that would create a conflict.    Initials:

Data Protection and Privacy — I acknowledge my responsibilities for protecting personal and company data in accordance with company policy.    Initials:

Intellectual Property and Work Product — I acknowledge that inventions, designs, and work product created in connection with my employment may be company property as set forth in company policy.    Initials:

Legal Disclosures

At‑Will Employment: I understand and agree that, unless set forth in a separate written agreement signed by an authorized representative of the company, my employment is at‑will and either I or the company may terminate the employment relationship at any time, with or without cause and with or without notice.

Equal Employment Opportunity: The company provides equal employment opportunity to all employees and applicants without regard to protected characteristics. I acknowledge receipt of the company's Equal Employment Opportunity statement.

I acknowledge the At‑Will Employment statement.

I acknowledge the Equal Employment Opportunity statement.

Authorization and Certification

I certify that the information I have provided on this form is true, accurate and complete to the best of my knowledge. I understand that any misrepresentation or omission may be grounds for disciplinary action, up to and including termination.

Background and Reference Checks: I authorize the company to contact my references and previous employers and to obtain criminal, credit, motor vehicle, and other background checks where permitted by law. I release all parties from liability for furnishing such information.

I authorize background checks and release of information as stated above.

I certify that all information provided on this form is true and complete and that I have read and understand the policies acknowledged above.

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