HR Video Release Form

HR VIDEO RELEASE FORM

A. Identification

Employee Name:

Company/Employer Name:

B. Personal & Position Information

Employment Start Date:    Salary / Rate:

C. Employment History (most recent first)

D. Education

Graduation Date:

E. Professional References

F. Video Release — Grant of Rights and Terms

For valuable consideration received, Employee hereby irrevocably grants to Employer, its affiliates, licensees and assigns a perpetual, worldwide, transferable, sublicensable, royalty-free right and license to record, reproduce, publish, distribute, display, perform, adapt and otherwise use Employee's image, voice, name, likeness, biographical information and performance (collectively, the "Materials") in any media now known or later developed for internal training, recruitment, marketing, advertising, public relations, broadcast and online distribution.

Employee expressly authorizes Employer to edit, alter, copy, exhibit, publish or distribute the Materials for any lawful purpose. Employee waives any right to inspect or approve finished product or any copy that may be used in connection with Materials and releases Employer from any claims related to distortion, blurring, alteration, optical illusion or use in composite form.

Compensation: Employee acknowledges that no further consideration, payment or accounting will be due for the rights granted hereunder beyond any compensation expressly agreed in writing. This release does not alter Employee's employment terms unless expressly set forth in a separate written agreement signed by Employer.

Release and Waiver: Employee hereby releases and forever discharges Employer, its officers, directors, employees, agents and representatives from any and all claims, demands, causes of action, liabilities and expenses (including attorneys' fees) arising out of or in connection with the use of the Materials, including but not limited to claims for invasion of privacy, rights of publicity, defamation, or other torts.

Moral Rights: To the extent permitted by applicable law, Employee waives any moral rights in the Materials and agrees not to assert such rights against Employer or its licensees or assigns.

G. Representations, Indemnity & Background Authorization

Employee represents and warrants that Employee has full authority to grant the rights described herein, that the Materials and Employee's participation do not violate any agreement or third-party right, and that no third-party consent is required. Employee agrees to indemnify and hold harmless Employer from and against any losses, damages or liabilities arising from breach of such representations.

Background Checks & References: Employee authorizes Employer and its agents to contact current and former employers and listed references and to obtain background checks as permitted by law for the purpose of verifying employment history and references. By checking the box below, Employee consents to such contacts and screening.

H. Employment Notices

At-Will Employment: Nothing in this release modifies any at-will nature of employment. Employment with Employer is at-will, unless otherwise provided in a signed written agreement.

Equal Opportunity: Employer is an equal opportunity employer. Decisions concerning assignment, promotion and employment are made without regard to protected characteristics and in accordance with applicable law.

I. Applicant Certification & Acknowledgments

I certify that all information provided in this form is true and complete to the best of my knowledge. I understand the rights I have granted to Employer under this release and that such grant is irrevocable with respect to Materials already created or used. I further acknowledge that I have read and understand this document and that I may seek independent counsel prior to signing.

I certify that I am at least 18 years of age: Yes No

If the signer is under 18 years of age, a parent or legal guardian must provide written consent on a separate document provided by Human Resources; signing below by an underage individual does not constitute valid consent unless countersigned by the parent or guardian as required by law.

J. Additional Notes

K. Acknowledgment of Policies

Employee acknowledges that use of the Materials will be governed by Employer policies regarding confidentiality, data protection and acceptable use. Employee agrees to comply with applicable policies and to report any concerns to Human Resources.

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