HR Mediator Letter

HR Mediator Letter

Date:

Recipient Information

Position Information

Background and Incident Summary

This letter confirms that Human Resources is offering a facilitated mediation concerning the workplace matter described below. Nature of concern: .

Date(s) of alleged incident(s): .

Proposed Mediation

Proposed mediator: . Contact for scheduling: .

Proposed mediation date and time: at . Location (or virtual): .

Confidentiality, Records, and Limitations

Mediation is voluntary. Communications made during the mediation session are intended to be confidential and inadmissible in subsequent administrative, civil or criminal proceedings to the fullest extent permitted by law. Confidentiality does not apply to disclosures:

• Required by law or court order;
• Which disclose an imminent threat to health or safety;
• That constitute an admission of wrongdoing subject to disciplinary action, where such admission is documented in a separate written agreement signed by the participant.

Any written settlement agreement reached as a result of mediation will be retained in the personnel file as appropriate. No other records of the mediation session will be placed in the personnel file without written consent.

Voluntary Participation and Non-Retaliation

Participation in mediation is voluntary. Choosing not to participate will not, by itself, be construed as an admission or be used as a basis for discipline. The organization prohibits retaliation against any employee who in good faith participates in mediation or raises concerns about workplace conduct.

Employee Employment History

Provide the two most recent prior employers.

Education

References

Provide three professional references.

Legal Disclosures

At-Will Employment: Nothing in this mediation letter alters the at-will employment relationship. Either the employee or the employer may terminate employment at any time, with or without cause or notice, unless a separate written agreement provides otherwise.

Equal Employment Opportunity: The organization maintains a policy of equal opportunity and prohibits unlawful discrimination and harassment. Mediation is offered as an internal dispute resolution process and does not replace any statutory or regulatory rights.

Authorization and Certifications

By signing below, the employee certifies that the information provided in this form is true and complete to the best of their knowledge, and acknowledges the voluntary nature of mediation. The employee further authorizes Human Resources to disclose relevant personnel records and to contact the references and prior employers listed above for purposes related to this matter.

I authorize background checks, reference checks, and verification of prior employment as necessary for HR's review of this matter:

I consent to background and reference checks.

Decision Regarding Mediation

Please indicate your choice:

I accept the mediation offer and agree to participate in good faith.

I decline mediation at this time and request alternative resolution or further HR review.

If accepting, identify any accommodations required to participate (e.g., interpreter, accessibility):

Acknowledgment and Signature

By signing below, the employee acknowledges receipt of this HR Mediator Letter, understands the voluntary nature of mediation, the confidentiality provisions described herein, and the organization's non-retaliation policy.

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