HR Authorized Signers Change Form

HR AUTHORIZED SIGNERS CHANGE FORM

Department:   Date of Request:   Effective Date:

Requestor / Personal Information

Phone:   Email:   Title:

Position Information

Current Start Date:   Current Annual Salary: $

Current Authorized Signers (List up to three)

Employee ID:   Phone:   Auth Level:

Employee ID:   Phone:   Auth Level:

Employee ID:   Phone:   Auth Level:

Requested Change

Action requested: Add signer    Remove signer    Modify signer details

Authorization Limits and Transaction Types

Per-transaction signing limit: $   Aggregate monthly limit: $

Transaction types authorized (check all that apply):
Accounts payable / vendor payments    Payroll approvals    Contract execution (commitment of funds)    Bank account maintenance / wire transfers

Supporting Documentation

Required attachments submitted with this request:
Organizational chart showing reporting lines    Government-issued ID or badge copy    Board/Executive resolution (if required)

Employment History

Employer 1

Dates Employed: From to

Employer 2

Dates Employed: From to

Education

Graduation Date:

References (Professional)

Phone:   Email:

Phone:   Email:

Phone:   Email:

Legal Disclosures and Certifications

At-Will Employment: The completion of this administrative form does not alter any individual's employment status. Employment remains at-will and may be terminated by the employer or the employee at any time, with or without cause or notice, unless there is a written agreement signed by authorized organizational representatives stating otherwise.

Equal Opportunity: The organization adheres to equal opportunity employment policies. Authorization of signatory status will be administered without unlawful discrimination.

Applicant Certification: I certify that the information provided on this form is true, complete, and accurate to the best of my knowledge. I acknowledge that false statements or omissions may result in disciplinary action up to and including termination of employment and recovery of any losses resulting from unauthorized actions.

Authorization to Verify: By signing below I authorize the organization to contact previous employers, references, and other appropriate parties to verify the information provided herein and to perform any background checks or credit checks required by policy for authorization of financial signing privileges.

Reason for Change / Requestor Statement

HR Review (For HR Use Only)

HR Review Outcome: Approved    Denied    If denied, reason:

HR Notes:

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