HR Procurement Form

HR PROCUREMENT FORM

Requester — Personal Information

Position & Assignment Information

Position Title:    Reporting Manager:

Proposed Start Date:    Estimated Duration (if temporary):

Procurement Request Details

Urgency: Routine Urgent Critical

Vendor / Supplier Information

Vendor Type: Goods Services Software Training Background Screening

Itemized Description of Goods / Services (complete all that apply)

Attachments & Background Checks

Required attachments (select all that apply): Vendor quote Statement of work Proposed contract Background check authorization

Corporate & HR Disclosures and Certifications

Procurement Certification — By submitting this form, the Requester certifies that funds are available and that this request complies with organizational procurement policies and applicable law. The Requester further certifies that no conflict of interest exists between the Requester (or immediate family members) and the listed vendor unless disclosed below.

Confidentiality & Data Protection — Any personal data exchanged in connection with this procurement will be handled in accordance with applicable privacy obligations and the organization’s internal policies. Where vendor access to employee data is required, the Requester must ensure a data processing agreement and appropriate safeguards are in place prior to disclosure.

Background Checks & Authorization — For vendor personnel or contingent workers who will access sensitive systems or employee records, HR is authorized to obtain background checks and verify employment history as necessary. The Requester certifies that necessary candidate authorizations have been obtained.

Equal Employment Opportunity Statement — The organization is an equal opportunity employer. Vendors and contractors engaged by the organization are expected to comply with applicable non-discrimination laws and organizational policies.

Applicant Certification & Authorization — I certify that all information provided on this form is true, complete, and accurate to the best of my knowledge. I authorize the organization and its agents to obtain and verify information necessary to evaluate this procurement request, including contacting vendors and, where applicable, previous employers or references. I understand that intentional misrepresentation may result in disciplinary action.

I certify and acknowledge the statements above

Employment History (Requester) — Required

Education

Professional References (Provide three)

Administrative Routing (internal use)

Routing checklist (to be completed by HR/Finance/Procurement as applicable):

HR review completed Budget approved Procurement approval obtained Contract executed (if applicable)

Certifications & Signatures

Certification of Accuracy — I certify under penalty of internal disciplinary action that the information provided on this form is accurate and complete and that all required internal procurement policies will be followed. I acknowledge that approval by Procurement or Finance is required prior to commitment of funds or signing of any agreement.

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