HR Service List

HR SERVICE LIST

Purpose: This HR Service List documents requested human resources services, associated funding information, and authorization to perform background or reference checks where applicable. Completion of this form initiates HR intake, scheduling, and any required approvals. Provide complete and accurate information; incomplete requests may delay service delivery.

Personal Information

Position Information

Requested Start Date:    Proposed Annual Salary:

HR Services Requested

Select services required and provide additional details where indicated. Selecting services certifies that funding approval will be pursued as noted below.

Target Completion Date:    Priority Level:

Cost Center & Billing

Estimated Cost:    Funding Approval Required:

Employment History (Most Recent First)

Dates Employed: From to

Dates Employed: From to

Education

Graduation Date:    Major / Field:

References

Legal Disclosures & Acknowledgments

At-Will Employment Statement: Where applicable, nothing in this request or any ensuing employment relationship alters the at-will nature of employment. The Employer retains the right to terminate employment at any time for lawful reasons unless an express written agreement states otherwise.

Equal Opportunity Statement: The Employer provides equal employment opportunity without regard to protected characteristics as defined by applicable law. Services will be provided in a manner consistent with nondiscrimination requirements.

Acknowledgement of At-Will Statement: I acknowledge and understand the At-Will Employment Statement.

Acknowledgement of Equal Opportunity: I acknowledge and understand the Equal Opportunity Statement.

Applicant Certification and Authorization

I certify that all information provided on this form is true, complete, and correct to the best of my knowledge. I authorize the Employer and its agents to contact my prior employers and listed references and to obtain background checks, education verifications, and other investigations necessary to process this request or to evaluate my qualifications for employment-related services. I understand that false statements or omissions may disqualify me from service or employment.

Authorization to Conduct Background Checks: I authorize the Employer to conduct background checks and verifications as necessary for the requested services.

HR Use Only

HR Intake Received By:    Date Received:

Funding Approval By (printed name):    Approval Date:

Notes on service scheduling and constraints: Please use the HR Notes field above to capture scheduling restrictions or dependencies (e.g., required approvals, vendor lead times, training availability).

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