HR Tenant Emergency Contact Form

HR Tenant Emergency Contact Form

Personal Information

Phone:    Email:

Position & Employment Information

Reporting Manager:    Employment Start Date:

Emergency Contacts

Primary Emergency Contact

Relationship:    Phone:

Alternate Emergency Contact

Relationship:    Phone:

Medical Information & Accessibility Needs

Vehicle & Pet Information

Vehicle Make/Model:    License Plate:

Authorizations, Consents, and Disclosures

By signing this form I authorize the employer/property manager and their authorized agents to contact the emergency contacts listed above and to disclose pertinent information to those contacts in the event of an emergency affecting my health or safety. I also authorize emergency medical personnel to provide treatment as deemed necessary.

I grant permission for authorized staff to access my residence or assigned unit without prior notice when there is a reasonable belief that an emergency exists presenting immediate risk to life, safety, health, or property. Such entry will be limited to actions necessary to address the emergency.

I understand that this form is used to facilitate emergency response and not to waive my privacy rights. Information provided will be maintained in accordance with applicable privacy and recordkeeping policies.

I consent to emergency contacts being notified and to release of necessary medical or situational information to those contacts.

I consent to entry of my unit by authorized staff or emergency responders in accordance with the authorization above.

Employment History (for verification and emergency context)

Employer 1

Title:    Dates Employed:

Employer 2

Title:    Dates Employed:

Education

Graduation Date:    Major / Field:

References (Professional)

Reference 1

Relationship:    Phone:

Reference 2

Relationship:    Phone:

Reference 3

Relationship:    Phone:

Legal Disclosures & At-Will Employment

At-Will Employment Statement: If applicable to your relationship with the employer, you understand and acknowledge that employment is at-will, which means either you or the employer may terminate the employment relationship at any time, with or without cause or prior notice, except as otherwise provided by law or a written agreement signed by an authorized representative.

Equal Opportunity: The employer/property manager is an equal opportunity entity. Decisions regarding housing, assignment, employment, or services are made without regard to protected characteristics and in accordance with applicable nondiscrimination laws.

Authorization to Verify and Release Information

I authorize the employer/property manager and their authorized representatives to verify the information provided on this form, to contact my listed references and previous employers for purposes of verification and emergency context, and to obtain relevant background or health-related information to the extent permitted by law. I release such parties from liability for providing truthful information in response to verification inquiries.

I authorize background checks and verification as described above where permitted by law.

Applicant Certification

I certify under penalty of perjury that the information provided on this form is true, complete and correct to the best of my knowledge. I understand that false statements or omissions may result in disciplinary action, including termination of employment, loss of housing privileges, or other remedies.

I agree to promptly notify the employer/property manager in writing of any changes to the emergency contact information provided herein.

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