HR Attestation Statement

HR ATTESTATION STATEMENT

Personal Information

Position Information

Reporting Manager:

Proposed Start Date:   Salary / Rate:

Employment History (Most Recent)

Job Title:   From:   To:

Job Title:   From:   To:

Education

Graduation Date:

Professional References

Legal Disclosures and Statements

At-Will Employment: I acknowledge that, if employed, my employment will be on an at-will basis unless otherwise expressly set forth in a written agreement signed by an authorized representative of the company. Either I or the employer may terminate the employment relationship at any time, with or without cause or notice.

Equal Opportunity: The employer provides equal employment opportunity to all employees and applicants without regard to race, color, religion, sex, national origin, disability, age, or any other protected characteristic. I understand that this is a policy of the employer and not a contract of employment.

Attestation and Authorizations

By checking each applicable box below and signing this document I make the following attestations, authorizations, and acknowledgments:

I certify that all information I have provided in this form and in any accompanying documents is true, correct and complete to the best of my knowledge. I understand that any misrepresentation or omission may result in denial of employment or immediate termination if employed.

I attest that I am legally authorized to work in the jurisdiction of employment and I agree to provide documentation verifying identity and employment authorization upon request.

I have disclosed all criminal convictions, pending charges, or administrative sanctions that are required to be disclosed for the position applied for, except where disclosure is prohibited by law. If disclosure is required, I have provided details in the space below.

I confirm that I have no known conflict of interest that would materially interfere with my duties, unless disclosed in writing to Human Resources.

I declare whether I am subject to any post-employment restrictive covenants (non-compete, non-solicit, confidentiality) from prior employers that could affect my ability to perform the duties of the position. If subject, provide description below.

I consent to pre-employment and/or reasonable suspicion drug and alcohol testing as required by the employer's policy and applicable law.

I authorize the employer and its agents to contact previous employers, educational institutions, references, and other organizations to verify the information I have provided and to obtain consumer reports, background checks, and other employment-related information as permitted by law.

Applicant Certification

I certify under penalty of disciplinary action and other remedies available to the employer that the statements and representations made on this form and in any supporting documentation are accurate and complete. I understand that falsification, omission, or failure to disclose material information may result in denial of employment, withdrawal of an offer, or termination. I understand that I may be required to submit to background screening and to provide documentation verifying identity and eligibility to work.

I further acknowledge that I have read and understand the attestations above and that my consent herein extends to the procurement of any information necessary to evaluate my suitability for employment, including but not limited to criminal history, education verification, employment verification, and reference checks, consistent with applicable law.

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