HR Signer Template

HR Signer Template

Personal Information

Position Information

Full-time    Part-time    Temporary    Contractor

Employment History

Employer 1

Employer 2

Education

References

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-will employment: I understand that, unless otherwise provided in a separate written agreement signed by an authorized representative of the employer, my employment is at-will. Either I or the employer may terminate the employment relationship at any time, with or without cause or advance notice. I acknowledge: I acknowledge and accept the at-will employment policy.

Equal employment opportunity: The employer maintains a policy of providing equal employment opportunity without regard to race, religion, color, national origin, sex, age, disability, or any other characteristic protected by applicable law. I acknowledge receipt of the employer's equal opportunity statement and understand that any questions regarding nondiscrimination may be directed to Human Resources.
I acknowledge receipt of the equal employment opportunity statement.

Authorization and Background Checks

By signing this form I authorize the employer and its agents to contact prior employers, educational institutions, references, licensing authorities and other third parties to verify information provided on this form and in accompanying documents. I further authorize the employer to obtain criminal history, motor vehicle, credit (where job-related and permitted by law), and other consumer reports as permitted by law. I understand that information obtained will be used only for employment-related decisions and in accordance with applicable law.

Consent (select as applicable):
Consent to contact references and prior employers
Consent to background/criminal history check
Consent to pre-employment drug/alcohol screening where permitted

If required for the position, I authorize the employer to obtain additional clearances or to request fingerprints and to release the results to the employer. I understand that any adverse result may be considered in accordance with applicable law and employer policy.

Applicant Certification

I certify that all information provided in this application, and any attachments, is true, complete and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application may result in rejection of the application or, if employed, disciplinary action up to and including termination.

Applicant agrees to release from liability any person or organization providing information to the employer in good faith in response to inquiries in connection with this application. Applicant understands that acceptance of an offer does not create a contractual obligation for employment for any specified period.

I certify under penalty of perjury that the information I have provided is true and correct.
I certify that the information provided is true and complete.

Authorization (print name inline): I, , authorize the inquiries and checks described above.

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