Employment Certificate

EMPLOYMENT CERTIFICATE

Personal Information

Employee Name:

Position Information

Job Title:

Reporting Manager:

Employment Start Date:    Current Salary/Rate:

Full-time Part-time Exempt Non-exempt

Employment History (Most Recent Prior Employers)

Dates Employed:

Dates Employed:

Education

Graduation Date:    Major/Field:

References

Legal Disclosures

At-Will Employment: Employment by the certifying employer is at-will unless an express written agreement signed by an authorized officer states otherwise. Either the employer or the employee may terminate employment at any time, with or without cause or notice, subject to applicable law.

Equal Employment Opportunity: The employer represents that it maintains employment practices consistent with equal opportunity obligations and does not discriminate on the basis of protected characteristics where applicable law prohibits such discrimination.

Applicant Certification and Authorizations

I certify that all information provided in this form is true, complete, and accurate to the best of my knowledge. I understand that material misstatements or omissions may be grounds for disciplinary action, up to and including termination.

I authorize the employer and its agents to contact prior employers, educational institutions, and references to verify the information provided and to conduct background checks including verification of employment dates, positions held, and performance records where permitted by law.

Applicant Printed Name:

Applicant Acknowledgement Date:

Employer Certification

The undersigned, an authorized representative of the employer named below, hereby certifies that, to the best of the undersigned's knowledge and based on company records, the information provided in this certificate regarding employment of the named employee is true and accurate. The employer expressly authorizes release of the foregoing information to the recipient of this certificate and acknowledges that this certificate is provided for purposes of verifying employment status, income, and related employment facts.

The employer makes no warranty, express or implied, regarding future employment or continued employment and disclaims liability for any actions taken by third parties who rely upon this certificate beyond direct misrepresentations known to the certifier at the time of signature.

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