Can this document be signed electronically?

Yes. Under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, electronic signatures are legally valid if intent, consent, attribution, and record retention are present.

Do you need a HIPAA BAA?

If the document contains protected health information, require a Business Associate Agreement with vendors and apply HIPAA safeguards; retain records for 6 years per 45 CFR §164.530(j).

When is notarization required?

Notarization is rarely required for internal HR inclusion forms, but state or agency submissions may require notarization; verify state rules before routing externally.

How long should records be kept?

Follow federal minimums—IRS 3 years and HIPAA 6 years where applicable—and extend retention if state law or internal policy requires longer periods.

What authentication strength is recommended?

Use at least email verification or SMS codes for routine cases; consider stronger authentication (KBA or multi-factor) for high-risk sensitive data access.

How do I limit access to sensitive fields?

Use role-based access controls and restricted field storage in your HR system; segregate medical notes into a secure, limited-access file with clear labeling.

Electronic Signature
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HR
Employment Inclusion Document

Employment Inclusion Document

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

EMPLOYMENT INCLUSION DOCUMENT

This Employment Inclusion Document collects personal, employment, and voluntary demographic information required to evaluate inclusion-related policies and to process an application for employment. Completion of the voluntary demographic sections is optional and will not affect hiring decisions. Information provided is confidential and used in accordance with applicable privacy and equal opportunity procedures.

Personal Information

Full Legal Name Current Address Primary Phone Email Address Preferred Pronouns (optional)

Position Information

Position Applied For / Job Title Department Hiring Manager / Reporting Manager Requested Start Date Salary Expectation

Employment History

Employer 1

Company Name Job Title

Start Date

End Date

Primary Responsibilities Reason for Leaving

Employer 2

Company Name Job Title

Start Date

End Date

Primary Responsibilities Reason for Leaving

Education

Highest Degree or Qualification Institution Graduation Date Major / Field of Study

Professional References

Reference 1

Name Phone Email Relationship

Reference 2

Name Phone Email Relationship

Reference 3

Name Phone Email Relationship

Inclusion / Voluntary Self-Identification

The following information is collected for affirmative action, equal employment opportunity, and inclusion monitoring. Submission of these responses is voluntary and will be kept confidential except as required by law.

Race / Ethnicity (select all that apply)

Hispanic or Latino Not Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White I choose not to disclose

Gender Identity

Female Male Non-binary / Third gender Prefer to self-describe: I choose not to disclose

Veteran Status

Not a veteran Veteran I choose not to disclose

Disability Status

I have a disability I do not have a disability I choose not to disclose

Accommodation Requests (if any)

Legal Notices and Authorizations

At-Will Employment: If an offer of employment is extended and accepted, the relationship will be at-will unless a written agreement signed by an authorized representative of the employer expressly provides otherwise. Either the employee or the employer may terminate the employment at any time, with or without cause or notice, subject only to applicable law.

Equal Employment Opportunity: The employer provides equal employment opportunity to all qualified applicants and employees without regard to race, color, religion, sex, national origin, age, disability, veteran status, gender identity, sexual orientation, or any other characteristic protected by law. Harassment and discrimination are not tolerated.

Authorization to Contact and Background Checks: By checking the consent box below and signing this document, I authorize the employer and its agents to contact my former employers, references, and educational institutions and to obtain consumer reports, background checks, and other information necessary to evaluate my application for employment. I understand that offers of employment may be conditioned on the results of such checks consistent with applicable law.

I authorize contact and background checks as described above

Applicant Certification

I certify that all information provided in this Employment Inclusion Document and any attachments is true, complete, and correct to the best of my knowledge. I understand that materially false statements, omissions, or misrepresentations may result in rejection of my application or, if employed, disciplinary action up to and including termination. I authorize the verification of any information provided and understand that this document becomes part of my personnel record if I am hired.

I certify the accuracy of the information provided in this document

Applicant Name:

Signature:

Date:

What the Employment Inclusion Document Is

The Employment Inclusion Document is an HR record used to document an employer's inclusion-related processes, accommodations, and nondiscrimination commitments for an employee or applicant. It commonly records requests for reasonable accommodation, diversity and accessibility acknowledgements, role-based inclusion expectations, or voluntary self-identification data collected for equal employment opportunity reporting. Although formats vary by employer and industry, the document typically becomes part of the personnel file, supports compliance with federal and state nondiscrimination laws, and establishes a documented trail for accommodation decisions and privacy controls.

Why maintaining a clear Employment Inclusion Document matters

A clear, consistent Employment Inclusion Document reduces legal exposure, documents accommodation decisions, and helps HR demonstrate compliance with nondiscrimination and accessibility obligations. It creates an auditable record that supports fair treatment and preserves evidence of interactive processes with employees and applicants.

Who typically completes and reviews this document

Keep distribution limited to those with a documented business need to protect privacy and comply with HIPAA, if health information is included.

HR managers and compliance teams who track accommodation requests and maintain personnel records
Hiring managers and supervisors responsible for implementing workplace adjustments and monitoring outcomes
Employees or applicants submitting voluntary self-identification, accommodation requests, or confidentiality preferences

Core elements to include in a professional Employment Inclusion Document

Design the document so each required element is clearly labeled and dated; use standardized fields for consistency across cases and audits.

Employee Identity

Full legal name, employee ID, job title, department, and contact details to ensure accurate record linkage across HR systems and personnel files.

Accommodation Request

Detailed description of the requested accommodation, dates requested, supporting documentation summary, and any limitations or timelines related to the request.

Interactive Notes

Chronological notes of conversations, assessments, and decisions taken by HR and managers to document the interactive process and rationale for outcomes.

Decision Summary

Formal statement of approval, modification, or denial with effective date, duration, and any review or renewal requirements for the accommodation provided.

Privacy Controls

Instructions on access restrictions, record redaction, and whether health data triggers HIPAA protections or restricted distribution within the organization.

Sign-off

Signature blocks for employee acknowledgment and authorized HR representative signature, including date and method of signature (wet or electronic).

Step-by-step: filling out the Employment Inclusion Document

Use this sequence to complete the form accurately and preserve an audit-ready record.

01

Gather information: Collect employee details and any supporting documentation before starting.
02

Describe request: Enter the accommodation request with dates and specific needs.
03

Assess options: Document alternatives considered and feasibility analysis.
04

Record decision: Sign, date, and retain the decision and any review schedule.

Configuring an online workflow for this document

Map fields, routing, and access controls before deploying the form in an eSignature platform to ensure correct routing and audit capture.

Field	Configuration
Employee Details	Required field; read-only after HR verification
Attachment Upload	Allow PDF or images; restrict access to HR group
Decision Field	Conditional visibility for approver only
Signature Block	Enable eSignature with audit trail capture

Where to send or file the Employment Inclusion Document

Routing depends on your organization. Typical sequence routes the document to HR, the employee's manager, and a designated compliance reviewer.

Employee: Completes initial request and attaches any supporting documents.
HR Review: Reviews documentation, documents the interactive process, and proposes accommodations.
Manager Input: Provides operational feasibility feedback and implementation steps.
Finalize: HR records decision, updates personnel file, and shares limited details per privacy rules.

Digital signing and distribution considerations

Ensure the platform you select can enforce role-based access, preserve signed copies, and store audit data for the required retention period.

Authentication: Email or SMS code
File formats: PDF, DOCX supported
Integrations: HRIS and cloud storage

Key timing and processing expectations

Adopt internal SLAs for request response, assessment, and implementation to stay compliant and responsive to employee needs.

Initial Acknowledgement:

Acknowledge receipt within 3 business days of submission to document the start of the interactive process.

Assessment Period:

Conduct assessment and propose accommodations within 10–30 business days depending on complexity.

Implementation Window:

Begin implementation within the timeframe agreed between HR and operational teams; document any delays.

Review Schedule:

Set periodic reviews for temporary accommodations and document outcomes and renewal needs.

Record Closure:

Close and archive the case once actions are complete and the employee acknowledges resolution.

Common mistakes when preparing an Employment Inclusion Document

Failing to record dates and decision rationale, which weakens the documented interactive process and audit trail.
Storing sensitive health details in unrestricted files instead of marking records as medical or confidential.
Using ambiguous language about accommodations (e.g., 'as needed') without objective implementation criteria.
Not limiting distribution to those with a business need, increasing privacy risk and regulatory exposure.

Potential legal risks from incorrect or incomplete documentation

Discrimination Claim: Exposure to EEOC or state claims if interactive process is undocumented

Privacy Violation: Improper disclosure of medical data may trigger HIPAA concerns

Recordkeeping Failure: Missing retention can impede defenses in litigation

I-9 Related: I-9 errors can lead to fines under 8 CFR

Incorrect Tax Info: Improper reporting of benefit changes may create IRS issues

Audit Findings: Regulatory audits may result from poor access controls

Real-world examples of how organizations use this document

These cases illustrate practical outcomes and how clear documentation supports operations and compliance.

Optica Ventures (COO)

The team standardized an online inclusion form to capture accommodation history and decisions.

The change reduced follow-up requests for clarification.
Brian Fitzgibbons reports the interface was simple for staff and customers, and the standardized record improved clarity during audits and internal reviews.

Fertility Centers of Illinois (Founder)

Implemented electronic routing for sensitive accommodation requests to limit access and capture approvals.

Routing included HR and a designated clinician.
John Butler said the platform and API integrations helped maintain compliance, secure records, and keep the process efficient across mobile and desktop.

eSignature vendor pricing and capability snapshot for this document

Compare entry pricing and common feature considerations for signing and distributing Employment Inclusion Documents; signNow is placed first for comparison consistency.

	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 plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Available (Business Premium)	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	Varies by plan	Varies by plan
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently asked questions about Employment Inclusion Documents

Answers to common operational and legal questions about completing, signing, and storing these documents.

Need help? Contact support

Can this document be signed electronically?
Yes. Under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, electronic signatures are legally valid if intent, consent, attribution, and record retention are present.
Do you need a HIPAA BAA?
If the document contains protected health information, require a Business Associate Agreement with vendors and apply HIPAA safeguards; retain records for 6 years per 45 CFR §164.530(j).
When is notarization required?
Notarization is rarely required for internal HR inclusion forms, but state or agency submissions may require notarization; verify state rules before routing externally.
How long should records be kept?
Follow federal minimums—IRS 3 years and HIPAA 6 years where applicable—and extend retention if state law or internal policy requires longer periods.
What authentication strength is recommended?
Use at least email verification or SMS codes for routine cases; consider stronger authentication (KBA or multi-factor) for high-risk sensitive data access.
How do I limit access to sensitive fields?
Use role-based access controls and restricted field storage in your HR system; segregate medical notes into a secure, limited-access file with clear labeling.

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