HR Activity Approval Form

HR ACTIVITY APPROVAL FORM

Request Information

Requestor Name:   Department:

Requestor Phone:   Requestor Email:   Date Submitted:

Employee / Subject Details

Job Title:   Department:   Location:

Activity Requested

Select the HR activity for which approval is requested. Check all that apply. If Other, provide details below.

Hire    Promotion    Transfer    Termination    Salary adjustment

Bonus    Leave of absence    Training enrollment    Background check    Other

Effective Date:   Proposed Last Date (if applicable):   Requested Salary / Amount:

Budget & Operational Impact

Cost Center / GL Code:   Estimated One-Time Cost:   Estimated Ongoing Cost:

Compliance & Risk Review

Will this activity change headcount? Yes No   Union/Collective Bargaining Impact? Yes No

HR Review (For HR Use Only)

HR Reviewer Name:   Date Reviewed:

HR Action: Approve    Deny    Hold

Finance & Legal Review (If required)

Finance Reviewer:   Date:

Legal Reviewer:   Date:

Applicant Certification & Authorizations

I certify that all information provided in this form and in any attachments is true, accurate and complete to the best of my knowledge. I understand that any materially false statement may be grounds for disciplinary action, up to and including termination.

Authorization: I authorize the Company and its agents to contact my current and former employers, educational institutions, and references as necessary to verify information provided. I further authorize background checks, drug screening (if applicable), and other verifications required for this activity, subject to applicable law.

Applicant Consent: I authorize background checks and contact with prior employers.

Employment History (Provide at least two)

Title:   Dates Employed:

Title:   Dates Employed:

Education

Degree / Credential:   Institution:

Graduation Date:   Major / Field:

Professional References (3)

Phone:   Email:   Relationship:

Phone:   Email:   Relationship:

Phone:   Email:   Relationship:

Policy Notices

At-Will Employment: Unless otherwise provided in a separate written agreement signed by an authorized representative of the Company, employment with the Company is at-will and may be terminated by the employee or the Company at any time, with or without cause or notice.

Equal Opportunity: The Company is an equal opportunity employer and bases employment decisions on merit, qualifications and business needs. The Company prohibits unlawful discrimination or harassment on the basis of legally protected characteristics.

Signatures

By signing below, the parties certify that they have reviewed this request and the attached documentation, and that the information contained herein is complete and accurate. Signatures constitute authorization to proceed with the approved activity consistent with company policy.

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