HR Vendor Application Form

HR Vendor Application Form

Use this form to apply to provide goods or services to the organization's human resources functions. Complete all sections fully. The representations and certifications made herein are material to the organization's decision to engage with the vendor and may be relied upon for contract formation, insurance verification, background screening, and compliance review.

Vendor Information

Corporation    LLC    Partnership    Sole Proprietor    Nonprofit/Governmental

Primary Contact

Services, Capabilities & Contract Information

Insurance, Licensing & Compliance

Provide current insurance coverage amounts and policy identifiers. Attach certificates where required. The organization may require additional insured endorsement and thirty (30) days' notice of cancellation for certain engagements.

Attachments included (check all that apply):

W-9 or equivalent tax document    Certificate of Insurance    Business License    Reference List

Prior Engagements (Employment History)

Provide at least two prior client or employment engagements for the primary contact or company that demonstrate relevant experience.

Education (Primary Contact)

Professional References

Provide three professional references who can attest to your performance on similar HR engagements.

Legal Disclosures

At-Will Employment Statement: To the extent this application or any resulting engagement involves the assignment of personnel to the organization, the organization’s relationship with any individual worker is at-will unless and only to the extent a separate written employment agreement executed by an authorized representative states otherwise. Nothing in this vendor application modifies at-will employment relationships between the organization and its employees.

Equal Opportunity and Non-Discrimination: The organization is an equal opportunity contractor. The vendor agrees to comply with applicable laws prohibiting discrimination in employment and services, and represents that it does not engage in unlawful discrimination in its hiring, assignment, or treatment of personnel assigned to the organization.

Certifications, Authorizations & Background Checks

Applicant Certification: I certify under penalty of law that the information provided in this application is true, complete and accurate to the best of my knowledge. I understand that materially false statements may be grounds for immediate disqualification or termination of any engagement.

Authorization: By signing below, I authorize the organization and its authorized representatives to contact the references and prior employers listed in this application and to obtain and review background checks, reference checks, insurance verification and any other information reasonably necessary to evaluate the vendor's qualifications and compliance. I further authorize release of information to the organization for these purposes.

Criminal History Disclosure: Has the company, its principals, or the primary contact been subject to any criminal conviction, regulatory enforcement action, or civil judgment related to fraud, theft, professional misconduct, or employment practices in the past seven (7) years?

No    Yes — if yes, provide details below.

Acknowledgment

I certify that I am authorized to execute this application on behalf of the vendor named above. I agree that the organization may rely upon the statements made herein in determining whether to enter into a vendor relationship. I acknowledge that additional documentation, certifications, or agreements may be required prior to contract execution.

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