HR Vendor Setup Request

HR VENDOR SETUP REQUEST

Request Summary

Requester Name:    Department:

Request Date:    HR Contact:

Vendor Legal and Payment Information

Federal Tax ID / EIN:    Tax Classification: Corporation LLC Individual/Sole Proprietor Partnership

Vendor Website / Primary NAICS:

Vendor Point of Contact (Personal Information)

Phone:    Email:

Payment & Banking Instructions

Preferred Payment Method: ACH Check Wire

Routing Number:    Account Number:    Account Type: Checking Savings

Scope of Services & Commercial Terms

Contract Start Date:    Estimated Annual Spend: $

Payment Terms (Net):    Purchase Order Required: Yes

Compliance, Insurance & Certifications

W-9 on file: Yes    Certificate of Insurance (COI) on file: Yes

Subcontractors permitted: Yes No

Additional Documentation Attached

Check all documents attached or on file: W-9 COI Master Services Agreement Voided Check / Direct Deposit Form Other

HR Standard Sections (Required)

Personal Information

Phone:    Email:

Position Information (Vendor Contact)

Department:    Reporting Manager (Internal):

Proposed Start Date:    Estimated Monthly Cost: $

Employment / Contractor History (Relevant)

Title:    Dates Employed:

Title:    Dates Employed:

Education

Graduation Date:

Professional References

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Legal Disclosures & Policies

At-Will Employment Statement: The relationship between the organization and any individual engaged as a contractor or employee through this vendor arrangement is at-will unless otherwise set forth in a signed agreement. Nothing in this form creates a guarantee of employment or a fixed-term contract.

Equal Opportunity Statement: The organization provides equal employment opportunity and does not discriminate on any protected basis. Vendors providing on-site personnel must adhere to the same nondiscrimination policies and shall ensure compliance by their personnel.

By signing below the requester certifies authorization to initiate vendor onboarding activities, including but not limited to verification of tax documentation, confirmation of insurance coverage and, when applicable, background checks of vendor personnel assigned to perform services. Vendor personnel assigned to perform services on-site may be subject to background screening requirements.

Vendor Certification and Indemnity

Certification: The vendor certifies that the information submitted on this form is true, complete and accurate. Vendor affirms that it is authorized to enter into contracts, that no material facts have been omitted, and that it will notify the organization promptly of any changes to the information provided.

Indemnity: Vendor agrees to defend, indemnify and hold harmless the organization, its officers and employees from and against any claims, losses or liabilities arising out of vendor performance, breach of this certification, negligence, willful misconduct, or failure to comply with applicable laws and contractual obligations.

Applicant / Requester Certification

I certify that all information provided in this HR Vendor Setup Request is true and complete to the best of my knowledge, and I authorize the organization to use this information to establish vendor records, verify documentation, and complete onboarding. I understand that intentional falsification may result in internal review and corrective action.

Authorization to Contact Previous Employers and References: I authorize the organization to contact the listed employers and references to verify information provided and obtain any records necessary to determine suitability for the requested vendor relationship.

Sign Now