HR Vendor Qualification Form

HR VENDOR QUALIFICATION FORM

Form Submission Date:

Vendor Company Information

Primary Contact / Personal Information

Position / Service Information

Primary Service Provided:

Employment History (Key Personnel)

Key Personnel 1

Key Personnel 2

Education

Professional References (3)

Insurance, Licenses & Compliance

Does your organization carry the insurance coverage listed below in effect for work performed for the client? (Provide certificates upon request.)

Regulatory and compliance attestations (check each that apply)

Legal Disclosures & HR Policies

At-Will Statement: Where applicable, the client's engagement of temporary or contract personnel supplied by the vendor is subject to the client's at-will employment policies and may be terminated at any time by the client. The vendor acknowledges that engagement of personnel does not create an employment relationship with the client unless otherwise agreed in writing in a signed contract between the parties.

Equal Opportunity Statement: The vendor certifies that it is an equal opportunity provider and does not discriminate in recruitment, hiring, assignment, promotion, compensation, or termination on the basis of protected characteristics. The vendor will ensure compliance with applicable equal opportunity and anti-discrimination laws in the performance of services.

Confidentiality and Data Handling: Vendor will maintain confidentiality of client and candidate data and will use such data only for performance of contracted services. Vendor shall implement and maintain administrative, technical, and physical safeguards appropriate to the sensitivity of data, and shall notify the client without undue delay in the event of a data breach affecting client data.

Background Checks & Authorization

The undersigned authorizes the client and its agents to contact the references and prior employers listed above and to obtain background reports, criminal history, education verification, and other pre-engagement screening required by client policy. Vendor acknowledges it will obtain any required consents from its personnel in accordance with applicable law.

Applicant Certification & Indemnity

Certification: I certify that all information provided in this form and accompanying documentation is true, accurate, and complete to the best of my knowledge. I understand that material misrepresentation or omission may result in disqualification from the vendor list or termination of any resulting agreement.

Indemnity: Vendor agrees to indemnify, defend and hold harmless the client and its officers, directors, agents and employees from and against any claims, liabilities, losses or expenses arising from vendor's breach of this certification, negligent acts, willful misconduct, or failure to comply with applicable laws in connection with services provided.

Acknowledgment and Signature

By signing below, the authorized representative attests that they are duly authorized to bind the vendor to the representations, certifications, and obligations set forth in this form. This attestation does not itself create an agreement for services; any engagement is subject to execution of a separate contract.

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