Employment Officer Exclusion Form

EMPLOYMENT OFFICER EXCLUSION FORM

Company Name:     Company Address:

Employment Officer Name:     Officer Title:

WHEREAS

WHEREAS, the Company engages personnel and third-party service providers to manage recruitment, hiring and employment oversight, and the parties desire to document the exclusion of the Employment Officer named above from specified employment decision responsibilities in order to avoid conflicts of interest, undue influence, or to effectuate an agreed operational control;

WHEREAS, the parties agree that the exclusion set forth in this form shall define the scope of responsibilities from which the Employment Officer is excluded, the applicable time period, and any replacement or compensation arrangements necessitated by the exclusion;

WHEREAS, the Company and the Employment Officer enter into this agreement to confirm the exclusion, the procedures for notice, and the remedies for breach.

SCOPE OF EXCLUSION

PAYMENT TERMS (IF APPLICABLE)

If the exclusion requires engaging a third-party or paying replacement costs, the Company agrees to the following payment structure.

TERM AND TERMINATION

Start Date:     End Date:

Either party may terminate this exclusion for cause upon written notice to the other party. Notice Period (days):

Upon termination, parties shall cooperate to effect an orderly transition of responsibilities and shall settle any outstanding payment obligations in accordance with Payment Terms.

CONFIDENTIALITY

The Employment Officer and the Company agree that all non-public information learned in connection with the performance or implementation of this exclusion, including candidate records, compensation data, investigative results, and internal deliberations, is confidential. Neither party shall disclose confidential information except (a) to personnel with a need to know to effectuate the exclusion, (b) as compelled by law with prior notice to the other party, or (c) with the other party's written consent.

REPRESENTATIONS, WARRANTIES AND REMEDIES

Each party represents and warrants that it has full authority to enter this document and that the execution and performance will not violate other agreements. A material breach of this form by the Employment Officer or the Company shall entitle the non-breaching party to injunctive relief and to recover reasonable costs, including attorneys' fees, incurred to enforce this agreement.

GOVERNING LAW

This form shall be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This form, together with any written addenda executed by the parties, constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior negotiations, understandings and agreements, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

ACKNOWLEDGMENTS

The Employment Officer acknowledges that they have read and understand the exclusion set forth herein and that continued performance of duties outside the excluded scope does not imply waiver of the exclusion. Check to affirm:

I acknowledge that I understand and will comply with the exclusion described in this form.

I certify that, to the best of my knowledge, the exclusion is not intended to conceal unlawful conduct or to avoid disclosure obligations and does not create an impermissible conflict of interest.

NOTICES

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