HR Statement of Integrity

HR STATEMENT OF INTEGRITY

Personal Information

Position Information

Proposed Start Date:   Salary (annual):

Statement of Integrity — Mandatory Acknowledgements

As a condition of employment and continued association with the organization, I acknowledge and agree to abide by the following standards. I understand that violation of these commitments may result in discipline up to and including termination, restitution, and/or civil or criminal prosecution where applicable.

Compliance with Laws: I will comply with all applicable laws, rules and regulations in the performance of my duties and will not engage in unlawful conduct while acting on behalf of the organization.

Conflicts of Interest: I will avoid and promptly disclose any actual or potential conflict of interest, including outside employment, financial interests, or relationships that could impair objective judgment.

Gifts and Hospitality: I will not solicit or accept gifts, favors, or hospitality that could reasonably be perceived to influence business decisions, except as permitted by the employer's gift policy and only with prior disclosure where required.

Confidentiality: I will protect confidential and proprietary information obtained during my employment and will not disclose or use such information except as authorized or required by law.

Duty to Report: I will promptly report suspected violations of law, policy, or ethical standards to the appropriate internal authority and cooperate fully with inquiries and investigations.

Authorization for Screening and Contacts

I expressly authorize the organization, its agents and authorized service providers to conduct employment-related background investigations, which may include verification of employment, education, professional licenses, criminal records, credit reports where job-related, and drug screening where applicable. I understand that any adverse findings may affect hiring or continued employment.

I consent to employment-related background checks and release the organization and any provider from liability for conducting such checks in accordance with applicable law.

I consent to drug and alcohol testing as permitted by policy and law and understand that refusal may be treated as a failure of a condition of employment.

I authorize the organization to contact previous employers, educational institutions and references for purposes of verifying my qualifications, employment history and fitness for employment.

Employment History (Most Recent First)

From:   To:

From:   To:

Education

Professional References

Legal Disclosures

At-Will Employment: I understand and acknowledge that, unless otherwise expressly provided in a separate written agreement signed by an authorized representative of the organization, my employment is at-will. Either the organization or I may terminate the employment relationship at any time, with or without cause and with or without notice, subject to applicable law.

Equal Opportunity: The organization is committed to providing equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information or any other status protected by applicable law. Employment decisions will be based on legitimate business reasons and the qualifications of applicants and employees.

Applicant Certification & Authorization

I certify that all information provided in this Statement of Integrity and any accompanying documents is true, complete and correct to the best of my knowledge. I understand that falsification, omission or misrepresentation of information may result in denial of employment or, if employed, termination of employment.

I authorize the release of information by former employers, educational institutions, references, and other third parties to the organization for the purpose of verifying statements made herein and evaluating my suitability for employment. I release such providers and the organization from liability for furnishing or using such information, provided they act in good faith and in accordance with applicable law.

By checking this box I certify and authorize as stated above.

Consequences of Violation

Violation of this Statement of Integrity may subject the employee to disciplinary action, up to and including termination of employment. The organization may pursue all available legal and equitable remedies, including restitution, injunctive relief, or referral for criminal prosecution if warranted.

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