HR Vendor Attestation Form

HR VENDOR ATTESTATION FORM

Vendor Name:     Client Name:

VENDOR INFORMATION

SERVICES AND CONTRACT INFORMATION

VENDOR REPRESENTATIVE / PRIMARY CONTACT

REPRESENTATIVE EMPLOYMENT HISTORY (Most Recent First)

EDUCATION

PROFESSIONAL REFERENCES (3)

LEGAL DISCLOSURES

At-Will Employment Statement: The vendor representative acknowledges that any individual engagement or contingent worker relationship made directly with the client is governed by the terms of the client-vendor agreement and that nothing in this attestation alters the at-will nature of employment relationships between the client and its employees. This statement does not create employment status between the client and vendor personnel.

Equal Opportunity Statement: Vendor certifies that it provides equal employment opportunity without regard to protected characteristics and that it does not engage in discriminatory hiring, compensation, assignment, promotion, termination, or other employment practices. Vendor further certifies compliance with all applicable laws prohibiting discrimination in employment.

ATTESTATIONS — CHECK ALL THAT APPLY

Vendor complies with all applicable labor, wage and hour, immigration verification, and child labor laws.

Vendor maintains policies prohibiting unlawful discrimination and harassment and will apply those policies to personnel assigned to the client.

Vendor conducts pre-placement background checks and obtains legally required authorizations prior to assigning personnel, and will provide confirmation of such checks upon request.

Vendor maintains required insurance coverages and will provide certificates of insurance upon request.

Vendor will not delegate performance to subcontractors without prior written approval from the client and will ensure subcontractor compliance with these attestations.

Vendor will maintain the confidentiality of client data and personnel information and will implement appropriate administrative, physical and technical safeguards to protect such information.

Vendor certifies that neither it nor its principals are subject to sanctions, debarment, or exclusion from government procurement or human resources programs.

INSURANCE AND COMPLIANCE DETAILS

AUTHORIZATION TO CONTACT AND BACKGROUND CHECKS

By checking the box below and signing this attestation, the vendor representative authorizes the client and its designated representatives to contact prior employers, references and to conduct or obtain background checks, credential verification, and other pre-engagement screening as permitted by law.

I authorize the client to conduct background checks and to contact previous employers and references as part of the vendor qualification process.

CERTIFICATION AND AUTHORIZED SIGNATORY

I certify that the information provided in this Vendor Attestation Form is true, complete and accurate to the best of my knowledge. I further certify that I am authorized to bind the vendor to the attestations and commitments made herein. I understand that false statements or material omissions may be grounds for rejection of the vendor, termination of contract, or other remedies available to the client. Vendor agrees to indemnify, defend and hold harmless the client from any claims arising from vendor's breach of these attestations or violation of applicable law.

This attestation shall be construed in accordance with the governing law set forth in any operative contract between the parties. If any provision is held invalid, the remaining provisions shall remain in full force and effect.

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