HR Purchase Order Substitute

HR PURCHASE ORDER SUBSTITUTE

This HR Purchase Order Substitute is an internal authorization to incur expense or contract third-party services specifically tied to human resources activities (including recruitment, contingent labor, background checks, training services, onboarding equipment, and related vendor services). Completion of this form constitutes a request for procurement and requires budgetary and HR approval consistent with organizational policies. All fields are to be completed truthfully and supporting documentation attached where indicated.

Request Summary

Requester Name:   Department:

Date of Request:    Cost Center / Account Code:

Vendor / Supplier Information

Items / Services Requested (Itemize each service or deliverable)

Estimated Unit Cost:    Quantity / Units:    Extended Cost:

Estimated Unit Cost:    Quantity / Units:    Extended Cost:

Total Estimated Cost:    Currency:

Budget & Funding

Yes    No

HR / Position Details (If purchase supports a hire or contingent worker)

Department:    Reports To:

Anticipated Start Date:    Employment Type:    FTE Equivalent:

Personal Information

Phone:    Email:

Employment History (Most Recent Two Employers)

Title:    From:    To:

Title:    From:    To:

Education

Graduation Date:    Major / Field:

Professional References

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Legal Disclosures & Certifications

At-Will Employment: I understand that employment with the organization, if extended, is on an at-will basis unless otherwise explicitly stated in a separate written agreement signed by an authorized representative of the organization.

Equal Opportunity: The organization provides equal employment opportunities without regard to protected characteristics in accordance with applicable law. Selection and procurement decisions shall comply with nondiscrimination requirements.

Applicant / Candidate Certification: I certify that all information provided on this form is true and complete to the best of my knowledge. I understand that false or misleading statements or material omissions may result in withdrawal of the hire offer or termination of employment.

Background and Reference Checks: I authorize the organization and its agents to contact prior employers, references, educational institutions and professional licensing authorities as necessary to verify information provided. I further authorize the organization to obtain consumer reports, criminal background checks, drug screening and other investigative reports where permitted by law. Consent: I consent

Release and Indemnity: Vendor and requester represent that vendor will comply with applicable laws regarding privacy and protection of personally identifiable information and will indemnify the organization for any breaches resulting from vendor negligence or willful misconduct, subject to contractual limits.

Procurement Compliance Acknowledgement

By submitting this form the requester certifies that: (1) funds are available or have been requested through the proper budget channels; (2) this procurement complies with organizational purchasing thresholds and required competitive procurement procedures; (3) any relationship with the proposed vendor that could present a conflict of interest has been disclosed to the appropriate officer; and (4) all information provided is accurate.

Approvals

Manager Approval (required):

Manager Signature:    Date:

Finance / Budget Office Approval (required where applicable):

Finance Signature:    Date:

Procurement Note: This document, when fully approved, serves as a substitute authorization for purchase and must be referenced on vendor invoices. The vendor must provide invoices and any deliverables consistent with the item descriptions above. Final contract terms, insurance requirements and confidentiality obligations will be established in a separate vendor agreement where required.

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