Employee PR Request Form

EMPLOYEE PR REQUEST FORM

Employee Information

Employee Name:    Employee ID:

Phone:    Email:    Hire Date:

Position Information

Reporting Manager:    Current Salary:    Requested Effective Date:

Full-Time    Part-Time    Contract    Exempt    Non-Exempt

Request Details

Promotion    Salary Increase    Performance Appraisal    Probation Completion    Other:

Self-Evaluation and Supporting Information

Employment History

Title:    Start Date:    End Date:

Title:    Start Date:    End Date:

Education

Graduation Date:    Certifications / Training:

References

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Legal Disclosures and Acknowledgements

At-Will Employment: I acknowledge that, unless governed by a separate written agreement signed by an authorized representative of the employer, my employment is at-will and may be terminated by either party at any time, with or without cause or notice.
I acknowledge and understand the at-will employment statement.

Equal Employment Opportunity: The company provides equal employment opportunity to all employees and applicants without regard to protected characteristics. Any decisions related to this request will be made in compliance with applicable nondiscrimination laws.
I acknowledge the Equal Employment Opportunity statement.

Authorization to Verify: I authorize the employer to review my personnel file, verify the information provided in this form, and contact previous employers and listed references for purposes related to this request. I further authorize the release of information necessary to evaluate this request.
I authorize verification and contact of prior employers and references.

Applicant Certification

I certify that the information provided in this Employee PR Request Form is true, complete, and correct to the best of my knowledge. I understand that any material misrepresentation or omission may result in denial of the request or disciplinary action, up to and including termination. I consent to the review of personnel records and the use of information submitted for personnel actions related to this request.

I certify that all information provided is true and complete.

Manager / HR Comments (For official use)

Privacy and Confidentiality

Information submitted in this form will be used only for the purpose of evaluating this request and related personnel actions. Access to this information is limited to personnel with a legitimate business need. Unauthorized disclosure of confidential personnel information is prohibited and may result in disciplinary action.

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