HR License Addendum

HR LICENSE ADDENDUM

This HR License Addendum (the "Addendum") is entered into effective as of Effective Date: by and between Employer Name: and Employee Name: .

Personal Information

Position Information

Start Date:    Annual Salary: $

License Details

Issuing Authority:    Issue Date:    Expiration Date:

Current Status: Active Inactive Suspended/Restricted

Employee Obligations

Employee represents and warrants that the license information provided above is true and complete and that Employee will maintain all required licenses in good standing for the duration of employment in the position specified. Employee further agrees to:

• Provide copies of renewed licenses and any notices of discipline, investigation, or restriction to the Employer within days of receipt.
• Promptly notify Employer in writing of any change in licensure status, suspension, revocation, or practice restrictions.
• Comply with all laws, regulations, and professional standards applicable to the licensed activity.

Employer Obligations and Reimbursement

Employer acknowledges that the specified license is a condition of employment for the position listed above. Employer obligations, if any, with respect to license maintenance and costs are as follows:

Employer will reimburse reasonable renewal or initial licensing fees upon submission of receipts: Yes No

Costs, Recovery, and Remedies

Employee agrees that any reimbursement provided by Employer for licensing costs may be subject to repayment by Employee if Employee voluntarily resigns or is terminated for cause within months of reimbursement, under terms to be documented by Employer policy.

Loss, suspension, or restriction of required licensure that prevents performance of essential duties constitutes grounds for discipline up to and including termination. Employer will consider reasonable accommodation where required by law.

Representations, Warranties and Indemnification

Employee represents that all information regarding licensure is accurate and current. Employee agrees to defend, indemnify, and hold Employer harmless from claims arising from Employee's failure to maintain required licensure or from Employee's acts or omissions that are outside the scope of lawful practice under the relevant license.

Authorization to Verify and Background Checks

Employee authorizes Employer to verify all license information, education, employment history, and professional references. Employee also authorizes Employer to obtain background checks and regulatory board records as necessary to confirm licensure and standing.

Authorization: I authorize verification of licensure and records

Employment History

Education

Professional References

Legal Disclosures

At-Will Employment Statement: Employment with Employer is at-will unless expressly provided otherwise in a written agreement signed by an authorized representative of Employer. Nothing in this Addendum alters at-will status except as specifically set forth in a separate signed agreement.

Equal Opportunity Statement: Employer affirms its commitment to equal employment opportunity and will not discriminate in employment decisions on any protected basis.

Applicant Certification: I certify that all information provided in this Addendum and accompanying documentation is true and complete to the best of my knowledge. I understand that false or misleading information may be grounds for denial of employment, discipline, or termination.

Certification Acknowledgment: I certify the above

Notices and Miscellaneous

Notices under this Addendum shall be in writing and delivered to Employer at Employer Notice Address: and to Employee at Employee Notice Address:

Governing Law: This Addendum will be governed by and construed in accordance with the laws of the State of , without regard to conflict of law principles.

Entire Agreement; Amendments: This Addendum, together with any referenced employment agreement or policies, constitutes the entire agreement between the parties regarding the subject matter herein. Any amendment must be in writing and signed by both parties.

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