HR Authorized Signatory Listing

HR AUTHORIZED SIGNATORY LISTING

Organization Name:

Effective Date of Listing:    Listing Prepared By:

Purpose and Scope

This document identifies individuals authorized by Human Resources to sign specified HR, employment and payroll related documents on behalf of the Organization. Authority granted here is limited to the specific categories and dollar limits, if any, set forth for each signatory. This listing supersedes prior internal authorization records only to the extent expressly noted.

Instructions

Complete all fields for each authorized signatory. Attach supporting documentation where required. Any revocation, amendment, or replacement of this listing must be submitted in writing and approved by the HR Director. Retain a copy of this form in the official HR records.

Authorized Signatory 1 — Personal Information

Position Information

Reporting Manager:    Start Date:    Salary (annual):

Employment History (Most Recent 2 Employers)

Title:    Dates Employed (From):    (To):

Title:    Dates Employed (From):    (To):

Education

Graduation Date:

References (3 Professional)

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Authority Scope — Signatory 1

Check all authorities granted to this signatory:

Offer letters and employment agreements    Non-disclosure agreements    Termination notices

Salary and compensation changes (specify limit below)    Authorization to request background checks

Legal Disclosures & Applicant Certification (Signatory 1)

At-Will Employment Statement: Employment and authority, unless otherwise set by a executed employment contract, remain at-will and may be modified or terminated by the Organization or the employee at any time, with or without cause.

Equal Employment Opportunity: The Organization provides equal employment opportunity and does not discriminate on the basis of protected characteristics in any employment practice or decision.

I acknowledge the At-Will and Equal Opportunity statements above.

I certify that all information provided in this signatory profile is true and complete to the best of my knowledge, and I authorize the Organization to verify any information provided, including contacting prior employers and conducting background checks where permitted by law.

Authorized Signatory 2 — Personal Information

Position Information

Reporting Manager:    Start Date:    Salary (annual):

Employment History (Most Recent 2 Employers)

Title:    Dates Employed (From):    (To):

Title:    Dates Employed (From):    (To):

Education

Graduation Date:

References (3 Professional)

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Authority Scope — Signatory 2

Check all authorities granted to this signatory:

Offer letters and employment agreements    Non-disclosure agreements    Termination notices

Salary and compensation changes (specify limit below)    Authorization to request background checks

I acknowledge the At-Will and Equal Opportunity statements above.

I certify that all information provided in this signatory profile is true and complete to the best of my knowledge, and I authorize the Organization to verify any information provided, including contacting prior employers and conducting background checks where permitted by law.

Authorized Signatory 3 — Personal Information (Optional)

Reporting Manager:    Start Date:    Salary (annual):

Recordkeeping & Revocation

This listing shall be retained by Human Resources in the official personnel records. Any revocation or modification of an individual’s authority must be provided in writing to HR and will be effective on the date indicated in the revocation notice. HR will notify relevant departments when authorities are added, changed, or removed.

HR Certification and Approval

The undersigned HR official certifies that the individuals listed above have been vetted and are authorized to execute documents and take actions only within the scope and limitations specified on this form. This approval is subject to the Organization's policies and applicable law.

Certification: By signing above, the HR Authorized By acknowledges responsibility for maintaining accurate records of authorized signatories and for communicating any changes to affected business units. The HR Authorized By confirms compliance with internal policies and applicable legal requirements with respect to delegation of signature authority.

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