HR Supplier Profile Form

HR SUPPLIER PROFILE FORM

Please complete this Supplier Profile Form in full. The information provided will be used to evaluate and register your company as an approved supplier for workforce, human resources, payroll-related, and related professional services. Submission of this form does not constitute contractual engagement. Supplier certifies that the facts supplied are true and correct and authorizes verification as indicated in the Certification and Authorizations section below.

Supplier Identification

Entity Type: Corporation LLC Partnership Sole Proprietor Non-Profit Government Other

Primary Business and Remittance Addresses

Primary Contacts

Services and Capabilities

Indicate the primary services your company provides (check all that apply):

Staffing / Temporary Workforce Payroll & Payrolling Services Background Screening Training & Development HR Consulting Benefits Administration Other

Insurance, Certifications, and Compliance

Minimum insurance requirements for services: Commercial General Liability of at least $1,000,000 per occurrence and $2,000,000 aggregate; Employers' Liability/Workers' Compensation as required by law. Supplier shall maintain required insurance and provide certificates of insurance naming the client as additional insured where applicable.

Policy Expiration Date:

Certifications and regulatory compliance (check all that apply):

Compliant with applicable labor and employment laws Data privacy and protection policies in place Anti-bribery and anti-corruption policies Not subject to economic sanctions or debarment

Remittance / Banking Information

Supplier References

Provide three professional references for engagements similar in scope and size to those anticipated.

Representative Personal & Employment Information

This section collects information for the individual authorized to represent the supplier and sign on its behalf.

Employment History (Most Recent — at least two)

Education

Graduation Date:

Legal Disclosures & Company Policies

At-Will / Relationship Statement: Submission of this Supplier Profile Form does not create an employment relationship between the supplier's personnel and the client. Supplier personnel are not employees, agents, or contractors of the client unless a separate written agreement expressly so states.

Equal Opportunity / Non-Discrimination: Supplier affirms that it complies with applicable equal employment opportunity laws and maintains policies that prohibit discrimination and harassment. Supplier shall not discriminate in hiring, assignment, or provision of services based on legally protected characteristics.

Conflict of Interest and Ethics: Supplier warrants that it has no conflicts of interest with the client and will disclose any potential or actual conflicts. Supplier agrees to comply with the client's standards of business conduct when performing services.

Certification, Authorizations, and Indemnification

Certification: I certify that the information provided on this form is true, complete, and accurate to the best of my knowledge. I acknowledge that material misrepresentations or omissions may constitute grounds for rejection, termination of any engagement, or other lawful remedies.

Authorization to Verify: By signing below, Supplier authorizes the client and its authorized agents to verify any information provided herein, including contacting references, prior employers, and verifying insurance, licensing, and financial information. Supplier authorizes background checks, security screening, and other pre-engagement screenings necessary for the scope of services.

Indemnification: Supplier shall indemnify, defend, and hold harmless the client and its officers, directors, agents, and employees from and against any and all claims, liabilities, losses, damages, costs, and expenses (including reasonable attorneys' fees) arising out of Supplier's performance, breach of this form, negligence, willful misconduct, or violation of law in connection with services provided.

Applicant-Style Authorization for Background and Employment Verification

I authorize the client and its agents to obtain and review consumer reports, criminal history records, and other background information relevant to the supplier relationship. I further authorize prior employers and references to disclose employment history, performance, and reasons for separation. I release all parties from liability for providing such information in good faith.

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