Employment Participant Release Form

Employment Participant Release Form

Participant Information

Position & Program Information

Reporting Manager:    Anticipated start date:    Stipend / Salary (if applicable):

Employment History

Employer 1

Employer 2

Education

Professional References

Legal Disclosures & Release

At-Will Employment: I understand that participation in this program or assignment does not alter any at-will employment relationship unless documented in a separate written agreement signed by an authorized representative of the employer. Either the employer or I may terminate my participation or employment at any time, with or without cause and with or without notice.

Equal Opportunity: The employer provides equal opportunity in all employment practices and program participation. Decisions are made without regard to protected characteristics as defined by law.

Release and Waiver of Claims: In consideration of being permitted to participate in the employer-sponsored program, I, on behalf of myself, my heirs, executors and assigns, hereby release and discharge the employer, its officers, directors, employees, agents and affiliates from any and all claims, liabilities, demands, actions or causes of action, known or unknown, arising out of or relating to my participation, including but not limited to claims for personal injury, property damage, or wrongful death, except where such claims arise from the employer's gross negligence or willful misconduct.

Assumption of Risk and Indemnity: I acknowledge that participation may involve inherent risks. I voluntarily assume all such risks and agree to indemnify and hold harmless the employer against any claims, damages or expenses, including reasonable attorney fees, arising from my conduct or participation except to the extent caused by the employer's gross negligence or willful misconduct.

Photographs, Recordings and Materials: I grant to the employer the right to take and use photographs, video or audio recordings of me, and to use my name, likeness and any work product created in connection with the program for lawful business purposes, including training, promotion and internal communications, without further compensation to me.

Confidentiality and Proprietary Information: I agree that during and after participation I will not disclose confidential information or trade secrets of the employer. All materials, inventions, and work products created in connection with the program are the exclusive property of the employer to the fullest extent permitted by law.

Background Check & Authorization

Authorization to Verify: I authorize the employer and its designated agents to verify information provided on this form and to conduct background investigations including employment verification, criminal records checks, education verification, and other screening as permitted by law. I release all parties providing such information from liability for damages that may result from furnishing such information.

Consent to Background Check: I consent to background and reference checks as described above.

Authorization to Contact Prior Employers: I authorize the employer to contact my prior employers and supervisors for purposes of verifying employment history and job performance.

Applicant Certification

I certify that all information on this form is true, complete and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may result in rejection of my participation or termination of my employment or participation in the program. I have read and understand the Release and Waiver of Claims, the Assumption of Risk, the Indemnity provision, and the Background Check Authorization above, and I knowingly and voluntarily agree to be bound by those provisions.

Applicant Initials:

Emergency Contact

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