HR Duplicate Notice

HR DUPLICATE NOTICE

This HR Duplicate Notice documents the controlled issuance of one or more duplicate personnel documents to an employee. It records the identity of the employee, the type(s) of duplicate document(s) issued, the reason for issuance, and the acknowledgement and authorizations required by the employer. Employee Name:

Personal Information

Position Information

Position Start Date:   Annual Salary or Rate:

Duplicate Document Details

Type(s) of duplicate document(s) issued (check all that apply):

Offer Letter
Employment Agreement
Form I-9 or Identity Documentation
Paystub or Payroll Statement
Tax Withholding Form
Company ID/Badge
Other (describe):

Reason for issuance of duplicate document(s):

Original Document Date(s):   Date Duplicate Issued:

Number of copies issued:   Method of issuance: In person Mail Secure email

Administration — HR Use Only

HR Notes (reason for duplication, verification steps taken, retention instructions):

Employment History (for verification)

Employer 1

Employer 2

Education

References (Professional)

Legal Disclosures

At-Will Employment: Nothing in this notice alters the at-will employment relationship between the employer and the employee. Either the employee or the employer may terminate employment at any time for any lawful reason, with or without cause or notice, unless a written agreement states otherwise.

Equal Employment Opportunity: The employer provides equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other characteristic protected by law. The issuance of duplicate documents will be performed in a nondiscriminatory manner.

Authorizations and Certifications

I certify that the information I have provided on this form is true and complete to the best of my knowledge. I understand that knowingly providing false information may result in disciplinary action, up to and including termination.

Background and Verification Authorization: I authorize the employer and its agents to contact prior employers, educational institutions, and references listed herein for employment verification and background checks as necessary to confirm the information related to this duplicate document request. I further authorize those entities to release relevant information to the employer for these purposes.

I authorize verification and background checks as described above.

Release and Indemnity: By accepting duplicate document(s), I agree to safeguard the duplicate(s) and to notify HR immediately if the duplicate(s) are lost, stolen, or compromised. I agree to indemnify the employer for losses arising from my failure to secure duplicate documents issued to me due to my negligence or intentional misconduct.

Applicant Certification

I certify under penalty of perjury that I am the individual named in this notice and that the information provided is accurate. I acknowledge receipt of the duplicate document(s) listed above and understand the employer's responsibilities and my obligations concerning those duplicate document(s).

Employee Acknowledgement: I acknowledge receipt of the duplicate document(s) indicated on this form and accept responsibility for the safekeeping of said duplicate(s).

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