Can this form be signed electronically?

Yes. Under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, electronic signatures are legally valid provided intent, consent, attribution, and record retention requirements are met.

When is a wet signature required?

Wet signatures are rarely required for internal employment evaluations. Exceptions include transactions specifically excluded from ESIGN/UETA or where a third party (court, regulator) requires an original.

How should PHI be handled on the form?

If the form contains protected health information, implement a BAA with the eSignature provider, limit distribution, and follow HIPAA retention rules (45 CFR §164.530(j)).

What authentication level is recommended?

Use email verification for routine evaluations; require SMS, KBA, or SSO for high-sensitivity responses or external third-party verifications to strengthen attribution.

How long must completed forms be retained?

Retain as required by relevant regulations and policy: IRS-related records 3 years (IRC §6501(a)), HIPAA 6 years (45 CFR §164.530(j)), and longer if state law or litigation demands it.

What if the evaluator refuses to sign electronically?

Offer alternative methods: allow a printed form with a wet signature, or provide notarization where required. Document the reason and store the signed copy with the case file.

Electronic Signature
Templates
Miscellaneous
Employment Evaluation Request Form

Employment Evaluation Request Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYMENT EVALUATION REQUEST FORM

Recitals

WHEREAS Requesting Party: (the Requester) seeks a professional employment evaluation of the individual identified below; and

WHEREAS Evaluating Party: (the Evaluator) has the qualifications and agrees to perform the evaluation on the terms set forth in this Request; and

WHEREAS the Requester and Evaluator desire to establish the Scope, Payment Terms, confidentiality protections and other terms governing the engagement described herein.

Request Details

Request Date Requesting Employer / Agency Requestor Contact Person Contact Title Requestor Address

Contact Phone

Contact Email

Subject Employee

Employee Full Name

Date of Birth

Employee ID / Badge #

Current Position

Evaluation Requested

Select requested services (check all that apply):

Vocational Assessment Psychological Testing Functional Capacity Evaluation Medical Record Review Other

If Other, specify Documents to be provided to Evaluator Requested Completion Deadline

Scope of Work

The Scope of Work defines the services to be performed by the Evaluator. Include specific assessments, testing protocols, interviews, record reviews and reporting requirements. The Evaluator will perform services consistent with professional standards and applicable licensing rules.

Payment Terms

Fees shall be paid by the Requester as follows. The Requester agrees to pay the Evaluator for services performed, including time, tests administered, report preparation, and reasonable travel and administrative expenses.

Total Fee Payment Schedule / Deposits Late Payment Fee

Payment is due in accordance with the schedule above. If payment is not received when due, the Evaluator may suspend services and/or terminate this engagement in accordance with the Term and Termination provisions below; the Requester remains obligated to pay for all services performed and expenses incurred to date.

Term and Termination

This engagement commences on Start Date: and continues through End Date: unless earlier terminated as provided herein.

Notice Period for Termination

Either party may terminate for material breach if the breaching party fails to cure within the notice period. Termination for non-payment entitles the Evaluator to payment for all services rendered and costs incurred prior to termination. Sections that by their nature survive termination, including Confidentiality and Governing Law, shall survive termination or expiration.

Confidentiality

The parties shall treat information exchanged under this Request as confidential and shall not disclose such information except as required by law or with the written consent of the disclosing party or as necessary to perform the evaluation. The Evaluator may include necessary factual information in the evaluation report; the content of the report shall be disclosed only to authorized recipients specified by the Requester or as otherwise required by applicable law. Confidentiality obligations shall survive termination for a period of years.

Authorization to Obtain Records

The Requester represents that it has obtained, or will obtain prior to disclosure, any required consent or authorization from the employee to release medical, personnel or other records to the Evaluator. The Requester agrees to provide copies of executed release forms if requested by the Evaluator and to indemnify the Evaluator for liabilities arising from unauthorized disclosures.

Employee Authorization Provided

Yes Pending

Governing Law

This Request and any resulting agreement shall be governed by and construed in accordance with the laws of the State of , without regard to conflict-of-law rules.

Entire Agreement

This Request, once accepted by the Evaluator in writing or by commencement of services, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior proposals, negotiations and agreements, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

Certifications and Acknowledgments

By submitting this Request, the Requester certifies that the information provided is true and correct to the best of its knowledge, that required authorizations will be obtained prior to disclosure of protected records, and that the Requester will comply with the Payment Terms set forth above. The Requester further acknowledges that the Evaluator will rely on the representations made in this Request.

Requester certifies the above and agrees to terms

Requesting Party:

By:

Date:

Evaluator / Provider:

By:

Date:

What the Employment Evaluation Request Form Is

An Employment Evaluation Request Form is a standardized document used by employers, human resources, or third-party administrators to request a formal performance or reference evaluation for a current or former employee. It organizes requester and subject details, the evaluation criteria, confidentiality terms, and signature blocks so responses are consistent and auditable. In U.S. workplaces this form often supports hiring, promotion, disciplinary, or credentialing decisions and can be executed on paper or electronically under ESIGN and UETA where no statutory exception applies.

Why a Structured Request Form Matters

A clear Employment Evaluation Request Form reduces ambiguity, ensures consistent data collection, documents consent and chain of custody, and speeds review cycles while creating an audit trail useful for compliance and dispute resolution.

Who Typically Prepares and Responds

Roles given here often map to access controls and signer authentication settings when the form is sent electronically.

HR managers and talent acquisition professionals who request structured evaluations for hiring or promotion decisions.
Supervisors and former employers who provide factual performance or reference information in response.
Compliance officers and legal counsel who review completed forms for regulatory or litigation purposes.

Step-by-Step: Fill and Send the Form

Follow these sequential steps to prepare, route, and receive a compliant evaluation response.

01

Prepare Form: Complete requester and subject fields; attach job description if needed.
02

Choose Delivery: Select secure email, portal, or eSignature service for transmission.
03

Authenticate Signer: Require email verification or SMS code for identity assurance.
04

Collect Response: Receive signed evaluation and store with audit trail.

Essential Components of a Professional Request

A well-constructed Employment Evaluation Request Form contains discrete sections that support clear responses, secure handling, and legal traceability.

Requester Details

Identifies the person or organization initiating the request, contact information for follow-up, and authority to request references or performance data.

Subject Information

Full legal name, employee ID or DOB, job title and the dates of employment to be evaluated to avoid mistaken identity and scope mismatches.

Evaluation Criteria

Structured questions or rating scales (attendance, skills, conduct) and space for narrative comments to ensure consistent comparisons.

Confidentiality Notice

Explains any restrictions on disclosure, retention rules, and whether the evaluation will be shared with the subject or third parties.

Signature and Consent

Signed acknowledgement by the evaluator and, if required, consent statement from the subject; includes date and signer role.

Submission Instructions

Clear routing details — where to return the completed form, acceptable file formats, and expected response timeframe.

Configure the Online Workflow

Typical online settings help automate routing, authentication, and retention for repeated use.

Field	Configuration
Auto-fill	Map HRIS fields to prepopulate employee data.
Routing Order	Set sequential approvals: requester → evaluator → HR reviewer.
Authentication	Email link, SMS code, or KBA for higher assurance.
Retention	Apply retention policy and export to secure storage.

Where to Send and How It’s Processed

Understand destinations and routing to avoid misdirection and speed responses.

Internal HR System: Upload completed forms to central HRIS or document repository.
Email Return: Accept signed PDFs via secure business email only.
Third-Party Vendor: Direct responses to background screening vendors if contracted.
Secure Portal: Use a company portal or eSignature platform for controlled access.

Technical and Integration Considerations

Ensure the chosen tools meet required compliance frameworks and keep an immutable audit record of signer actions.

File Formats: PDF, DOCX, or PDF/A for long-term preservation.
Integrations: Connect to HRIS, ATS, and cloud storage (Salesforce, NetSuite, Google Workspace).
Authentication: Support email, SMS, KBA, or SSO depending on sensitivity.

Expected Timelines and Response Targets

Set realistic deadlines and document processing expectations so requestors and evaluators align on timing.

Evaluator Response Window:

Typically 7–14 calendar days to return completed evaluations.

HR Processing Time:

Allow 3–5 business days to review and file returned forms.

Escalation Period:

If no response in 30 days, escalate to a secondary contact.

Retention Start Date:

Retention begins on the form’s signed date.

Records Access Requests:

Allow reasonable time to fulfill internal access or subject information requests.

Common Mistakes to Avoid

Incomplete identifiers: failing to include employee ID or DOB leads to mismatched records and slow verification.
Using unsecured email to send PHI or sensitive performance details increases the risk of unauthorized disclosure.
Vague questions on the form produce inconsistent answers and make comparisons between candidates unreliable.
Missing signature dates or unsigned responses render evaluations difficult to verify for compliance or legal purposes.

Risks and Potential Consequences

Privacy Breach: Regulatory and reputational exposure.

Delayed Hiring: Operational impact from slow or missing responses.

Invalid Documentation: Unsigned or altered forms may be inadmissible.

I-9 Noncompliance: Associated documentation fines possible.

Discrimination Claim: Incomplete records may hinder defense.

Data Retention Risk: Failure to retain may impede audits.

Security and Compliance Essentials

Encryption: TLS 1.2/1.3; AES-256

Audit Trail: Detailed signer activity logs

HIPAA: BAA required for PHI

ESIGN / UETA: Legally recognized framework

Access Controls: Role-based permissions

Certifications: SOC 2 Type II, ISO 27001

eSignature Pricing Snapshot for Employment Evaluation Workflows

Comparison of common vendor entry-level pricing and capabilities relevant to recurring evaluation requests; signNow is listed first per vendor ordering rules.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions

Answers to common questions about validity, signatures, privacy, and handling of Employment Evaluation Request Forms.

Need help? Contact support

Can this form be signed electronically?
Yes. Under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, electronic signatures are legally valid provided intent, consent, attribution, and record retention requirements are met.
When is a wet signature required?
Wet signatures are rarely required for internal employment evaluations. Exceptions include transactions specifically excluded from ESIGN/UETA or where a third party (court, regulator) requires an original.
How should PHI be handled on the form?
If the form contains protected health information, implement a BAA with the eSignature provider, limit distribution, and follow HIPAA retention rules (45 CFR §164.530(j)).
What authentication level is recommended?
Use email verification for routine evaluations; require SMS, KBA, or SSO for high-sensitivity responses or external third-party verifications to strengthen attribution.
How long must completed forms be retained?
Retain as required by relevant regulations and policy: IRS-related records 3 years (IRC §6501(a)), HIPAA 6 years (45 CFR §164.530(j)), and longer if state law or litigation demands it.
What if the evaluator refuses to sign electronically?
Offer alternative methods: allow a printed form with a wet signature, or provide notarization where required. Document the reason and store the signed copy with the case file.

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