Employee Privacy Declaration

EMPLOYEE PRIVACY DECLARATION

Employee Name:    Employee ID:

PERSONAL INFORMATION

POSITION INFORMATION

Reporting Manager:    Start Date:    Salary/Rate:

EMPLOYMENT HISTORY

Dates Employed: From to

Dates Employed: From to

EDUCATION

Graduation Date:

PROFESSIONAL REFERENCES

LEGAL DISCLOSURES

At-Will Employment: The relationship between the employee and the employer is at-will, which means that either the employee or the employer may terminate the employment relationship at any time, with or without cause or prior notice, except as may be otherwise provided by a written agreement signed by an authorized representative of the employer.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are based on legitimate business reasons and not on any protected characteristic. This Privacy Declaration does not modify or supersede the employer's obligations under applicable equal opportunity laws.

PRIVACY AND DATA USE AUTHORIZATION

Definitions: For purposes of this Declaration, “personal data” means information that identifies or reasonably can be used to identify an individual, including contact information, employment history, payroll information, identification numbers, performance records, biometric data, and other HR-related records.

Purpose and Scope: The employer collects and processes personal data for legitimate business purposes including recruitment, onboarding, payroll, benefits administration, performance management, safety and security, compliance with legal obligations, and workplace investigations. The employee acknowledges that such processing is necessary for the employment relationship.

Categories of Data: The employee understands and consents that the employer may collect identifiers, contact details, employment and education history, compensation and benefits data, health-related information when necessary for benefit administration, criminal history where permitted, and biometric identifiers where the employer implements biometric systems.

Disclosure to Third Parties: The employee consents to disclosure of personal data to service providers, background screening firms, benefits carriers, government agencies, law enforcement where required by law, and to other recipients when necessary to accomplish the purposes described above. Such recipients are authorized to use the data only for those purposes.

Background Checks & Employment Verification: The employee authorizes the employer to verify employment history, education, professional licenses, references, and to obtain criminal record, credit, and other background checks as permitted by law. Consent is conditional on applicable legal limitations; the employee may revoke consent only as provided by law, but revocation may affect continued employment or eligibility for certain positions.

Monitoring and Electronic Communications: The employee acknowledges that workplace systems, devices, and communications may be monitored, accessed, and retained in accordance with company policies and applicable law. Personal use of employer systems may be subject to monitoring and administrative access.

Retention and Security: The employer will retain personal data only as long as necessary for business or legal purposes and will implement reasonable administrative, technical, and physical safeguards to protect personal data against unlawful access, disclosure, or destruction.

Access and Correction: The employee may request access to or correction of personal data maintained by the employer. Requests will be handled in accordance with the employer's procedures and applicable law.

Consequences of Non-Consent: If the employee does not consent to the collection or processing necessary for employment, the employer may be unable to hire or continue to employ the individual, or to provide certain benefits or access to facilities and systems.

CONSENTS AND AUTHORIZATIONS

By checking the boxes below, the employee provides the following specific consents and authorizations:

I authorize the employer to obtain background checks, criminal record checks, and other pre- or post-employment screening as permitted by law.

I authorize former employers, educational institutions, references, and other parties to provide employment, education, and reference information to the employer.

I consent to the collection and use of biometric identifiers (e.g., fingerprints, facial recognition) where implemented for security, timekeeping, or safety, subject to employer policies and legal restrictions.

I acknowledge and accept that employer systems and devices may be monitored and that such monitoring may involve collection and processing of personal data.

EMPLOYEE CERTIFICATIONS AND ACKNOWLEDGMENTS

I certify that all information I have provided in this Declaration and accompanying materials is true and complete to the best of my knowledge. I understand that knowingly providing false information or withholding material information may subject me to disciplinary action up to and including termination of employment.

I acknowledge that I have read and understand the employer's privacy practices and that I have had the opportunity to ask questions. I authorize the employer to process my personal data for the purposes described in this Declaration and for other purposes necessary to the employment relationship.

I further authorize the employer to contact the references listed above and to verify the employment and education information I have provided. I waive any claim against any person or entity providing such information in good faith.

ACKNOWLEDGMENT OF RECEIPT

I acknowledge receipt of this Employee Privacy Declaration and understand that it is part of my employee record. I further acknowledge that the employer may update this Declaration and that revised terms may be provided to me in writing.

AUTHORIZATION TO CONTACT PREVIOUS EMPLOYERS

I authorize the employer and its agents to contact the previous employers identified in this form and to request and receive information regarding my employment, performance, and reasons for separation. I understand that this authorization remains valid for the duration of my employment unless revoked in writing.

EMPLOYEE ADDITIONAL INFORMATION (OPTIONAL)

SIGNATURE

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