Employee Registration Package

EMPLOYEE REGISTRATION PACKAGE

Client Name:    Date:

Personal Information

Date of Birth:    Social Security Number:

Mobile Phone:    Personal Email:

Emergency Contact

Relationship:    Phone:

Position Information

Department:    Reporting Manager:

Start Date:    Employment Type: Full-time Part-time Temporary Contractor

Employment History (Most Recent First)

Employer 1

Job Title:    Start Date:    End Date:

Employer 2

Job Title:    Start Date:    End Date:

Education

Graduation Date:    Major / Field:

References (Professional)

Reference 1

Name:    Phone:

Email:    Relationship:

Reference 2

Name:    Phone:

Email:    Relationship:

Reference 3

Name:    Phone:

Email:    Relationship:

Legal Disclosures and Authorizations

At-Will Employment: I acknowledge that my employment, if any, is at-will and may be terminated by me or the employer at any time, with or without cause or notice, unless a separate written agreement signed by an authorized representative of the employer provides otherwise. I understand that no representative other than an authorized officer has the authority to enter into any agreement to alter the at-will nature of employment.

Equal Opportunity: The employer maintains a policy of equal employment opportunity. Hiring decisions are made without regard to race, color, religion, sex, national origin, age, disability, or other protected characteristic under applicable law. Reasonable accommodations are available upon request to the extent required by law.

Authorization for Background Checks and Reference Verification: I authorize the employer and its agents to investigate my background, education, criminal history, credit history (where job-related and permitted by law), driving record, and employment references as deemed necessary. I authorize previous employers, educational institutions, and references to release information concerning my employment, education, and character. I release all parties from liability for providing such information.

Drug and Alcohol Testing: If required by position, I consent to pre-employment and post-offer drug and alcohol screening and any subsequent testing consistent with company policy and applicable law. Refusal to submit to required testing may result in withdrawal of an offer or termination.

Consent (select to indicate consent): I authorize background and reference checks I consent to drug/alcohol testing if required I consent to credit check (if applicable)

Employment Eligibility

Citizenship / Work Authorization (check one): U.S. Citizen Lawful Permanent Resident Other authorized to work    If Other, specify:

Direct Deposit (Optional)

Bank Name:    Account Type: Checking Savings

Applicant Certification

I certify that all information provided in this Employee Registration Package is true, complete, and accurate to the best of my knowledge. I understand that any false statement, omission, or misrepresentation may disqualify me from employment or result in termination. I authorize the employer to obtain and verify the information provided and to retain this form as part of my personnel file.

I understand that completion of this document does not constitute a guarantee of employment. I understand that employment, if offered, may be conditioned on satisfactory completion of pre-employment checks and compliance with company policies.

Release: I hereby release from liability any person or organization that provides information in good faith in response to inquiries made in connection with this registration. I waive any right to inspect letters of reference provided in connection with my application.

Authorization Acknowledgment: I certify that the information above is truthful and complete I authorize release of information as described above

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