HR Risk Information Document

HR Risk Information Document

Document Purpose and Instructions

This form collects personnel, position and risk-related information to support pre-employment screening, onboarding risk assessments and periodic HR reviews. Complete all applicable sections fully and accurately. Incomplete or false information may affect suitability for assignment to positions that involve financial responsibility, sensitive data access, travel, driving, safety-sensitive duties, or management authority.

The document includes: personal and position data; categorized risk indicators; employment history; education and references; legal disclosures and applicant certifications; and authorization to conduct background checks and verify prior employment. Signature required at end from the individual named below.

Personal Information

Position Information

Risk Categories (select all that apply)

Access to personal or confidential data

Financial responsibility, transactions or reconciliation

Driving on company business or regular travel

Security clearance or vetted access required

Work with minors or vulnerable populations

Handling hazardous materials or equipment

Public-facing role or media representation

International assignment or cross-border duties

Criminal History and Discipline

Has the applicant been convicted of, or pled guilty or no contest to, any criminal offense, excluding minor traffic violations, or are there any pending criminal charges?

Yes No

Conflicts of Interest & Financial Disclosures

Do you have any financial interests, outside employment, or relationships that could reasonably be perceived as a conflict with duties in the position identified above?

Yes No

Driving and Background Check Information

Will the position require driving company vehicles or operating a personal vehicle for company business?

Yes No

Employment History

Employer 1

Employer 2

Education

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures and Authorizations

At-Will Employment: If this form is part of an application or onboarding for an employee role, employment with the organization is at-will unless a written agreement signed by an authorized company representative expressly states otherwise. Nothing in this form creates a contract of employment for any specified period.

Equal Opportunity: The organization prohibits unlawful discrimination and will consider applicants and employees without regard to protected characteristics. Reasonable accommodations will be considered where required by law.

Authorization to Verify: I authorize the organization and its agents to verify any information provided on this form, to obtain consumer and/or investigative background reports (which may include criminal history, driving records and credit reports where job related), and to contact prior employers, references and educational institutions for purposes of assessing suitability and risk for the position identified above. I understand that a conditional offer may be rescinded based on results required by the position and consistent with applicable law.

I authorize the verification and background checks as described above.

Applicant Certification

I certify that the information provided on this HR Risk Information Document is true, complete and correct to the best of my knowledge. I understand that omission, falsification or misrepresentation of information may result in denial of employment, withdrawal of an offer, or disciplinary action up to and including termination. I agree to notify HR promptly of any changes in circumstances that could affect my suitability, clearance, or legal status related to employment.

I certify the above statement

Recommended Controls / HR Comments (for reviewer use)

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