Employee Rewards Program

EMPLOYEE REWARDS PROGRAM ENROLLMENT & ACKNOWLEDGEMENT

This Employee Rewards Program Enrollment & Acknowledgement ("Program Enrollment") documents enrollment in the employer's rewards program and records the employee's elections, acknowledgements, and consents. Participation is subject to program rules, eligibility criteria, and administrative interpretation. By enrolling, the employee agrees to the terms set forth in this document and any plan provisions adopted by the employer.

Personal Information

Position Information

Date of Continuous Service (hire date):

Program Enrollment & Reward Election

Select reward tracks and preferred redemption method. Employee may change elections per program rules; changes may be subject to administrative approval and blackout periods.

Eligibility, Accrual, and Redemption Terms

Eligibility: To be eligible for rewards, an employee must be active, not on leave of absence, and in good standing on the date rewards are granted. The employer retains discretion to determine eligibility and may exclude employees covered by specific collective bargaining agreements when applicable.

Accrual: Reward points and awards accrue in accordance with program rules and may be subject to minimum thresholds, vesting periods, or performance review. Points have no cash value until redeemed in accordance with program procedures.

Redemption: Redemption requests may be processed through payroll, accounts payable, or a third-party administrator designated by the employer. The employer may impose limits, blackout periods, and administrative fees. Redemption is subject to verification of eligibility and program compliance.

Tax Withholding and Reporting

Acknowledgement: Employee acknowledges that rewards may be taxable and that the employer will withhold and report taxes as required by law. The employer will determine tax treatment and withhold applicable federal, state, and local taxes. For rewards issued as non-cash items, the employer may determine and report the fair market value for tax purposes.

Adjustment, Clawback, and Program Modification

Adjustment and Clawback: The employer reserves the right to adjust, rescind, or recover rewards where payment was made in error, where the employee is later determined ineligible, or where misconduct, material error, or fraud is discovered. Recovery may be effected through payroll deduction to the fullest extent permitted by law or other lawful means.

Program Modification: The employer retains sole discretion to amend, suspend, or terminate the rewards program at any time. Amendments may be applied prospectively unless otherwise required by law or expressly stated in writing by the employer.

Data Privacy and Use

Data Use: By participating in the program, employee consents to the collection, use, and disclosure of personal data necessary for program administration, verification of eligibility, tax reporting, and audit. Personal information will be handled consistent with employer policies and applicable privacy laws.

Conflict of Interest and Code of Conduct

Employee represents that acceptance of a reward will not result in a conflict of interest with the employee's duties. Any actual or potential conflicts must be disclosed to the employee's manager or human resources. Rewards obtained in violation of program rules or code of conduct may be rescinded.

Employment History (Most Recent Employers)

Provide details for at least two prior employers to assist with verification and program eligibility review.

Education

Professional References (3)

Acknowledgements, Certifications and Authorizations

I certify that all information provided in this Program Enrollment is true, complete, and correct to the best of my knowledge. I understand that false statements or omissions may result in denial of eligibility, rescission of rewards, or disciplinary action up to and including termination.

Authorization to Contact and Background Check: I authorize the employer and its agents to contact current and former employers, references, and other entities to verify the information provided and to obtain information relevant to program eligibility. I further authorize any background checks permitted by law that are necessary for the administration of the rewards program.

Release: I release from liability any person or entity that provides relevant information to the employer in good faith in response to an inquiry concerning my eligibility for the program.

Optional — Nomination / Justification

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