Policy Acknowledgment Form

POLICY ACKNOWLEDGMENT FORM This form records that you have received, read, understood, and agree to comply with the specific policies listed below. EMPLOYEE INFORMATION Name: [First Name] [Last Name] | Employee ID: [Number] Title: [Title] | Department: [Department] Effective Date: [Date] SECTION A: POLICY CHECKLIST Check each policy you have reviewed. By checking, you confirm you have read it in full and understand your obligations. Core Policies: ☐ Code of Conduct — Version [X], dated [Date] ☐ Anti-Harassment & Non-Discrimination — Version [X], dated [Date] ☐ Equal Employment Opportunity — Version [X], dated [Date] ☐ Confidentiality & Data Protection — Version [X], dated [Date] ☐ IT & Social Media Usage — Version [X], dated [Date] ☐ Leave Policy — Version [X], dated [Date] ☐ Attendance & Overtime — Version [X], dated [Date] ☐ Expense Reimbursement — Version [X], dated [Date] ☐ Travel Policy — Version [X], dated [Date] ☐ Drug & Alcohol Policy — Version [X], dated [Date] ☐ Health & Safety — Version [X], dated [Date] ☐ Remote Work / Hybrid — Version [X], dated [Date] ☐ Employee Referral — Version [X], dated [Date] Role-Specific (if applicable): ☐ [Policy 1] — Version [X], dated [Date] ☐ [Policy 2] — Version [X], dated [Date] SECTION B: ACKNOWLEDGMENT I acknowledge that: 1. I have received, read, and understood each policy I have checked. 2. I agree to comply fully with all policies, procedures, and standards described. 3. Violations may result in disciplinary action up to and including termination. 4. Policies may be updated; I am responsible for reviewing updated versions. 5. If I have questions, I will seek clarification from my manager or HR. SECTION C: SIGNATURE Employee Signature: _______________________ Date: _______________________ HR Use: ☐ Acknowledgment recorded in employee file Verified by: [HR Name] | Date: [Date]