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AT WILL EMPLOYEE This Employment Agreement for \"At Will\" Employee (the \"Agreement\") is made and effective this [DATE], BETWEEN: [EMPLOYEE NAME] (the \"Employee\"), an individual with his main address at: [COMPLETE ADDRESS] AND: [YOUR COMPANY NAME] (the \"Corporation\"), an entity organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at: [YOUR COMPLETE ADDRESS] RECITALS In consideration of the covenants and agreements herein contained and the moneys to be paid hereunder, the Corporation hereby employs the Employee and the Employee hereby agrees to perform services as an employee of the Corporation, on an \"at will\" basis, upon the following terms and conditions: APPOINTMENT The Employee is hereby employed by the Corporation to render such services and to perform such tasks as may be assigned by the Corporation. The Corporation may, in its sole discretion, increase or reduce the duties, or modify the title and job description, of the Employee from time to time, and any such increase, reduction or modification shall not be deemed a termination of this Agreement. ACCEPTANCE OF EMPLOYMENT Employee accepts employment with the Corporation upon the terms set forth above and agrees to devote all Employee's time, energy and ability to the interests of the Corporation, and to perform Employee's duties in an efficient, trustworthy and business-like manner. DEVOTION OF TIME TO EMPLOYMENT The Employee shall devote the Employee's best efforts and substantially all of the Employee's working time to performing the duties on behalf of the Corporation. The Employee shall provide services during the hours that are scheduled by the Corporation management. The Employee shall be prompt in reporting to work at the assigned time. NO CONFLICT OF INTEREST Employee shall not engage in any other business while employed by the Corporation. Employee shall not engage in any activity that conflicts with the Employees duties to the Corporation. Employee shall not provide any service or lend any aid or assistance to any party that competes with the services offered by the Corporation. Employee shall not provide any services to clients or prospective clients of the Corporation outside of the provision of services for the Corporation, whether such services are provided with or without compensation or remuneration. CORPORATION PROPERTY Employee acknowledges and agrees that while employed by the Corporation the Employee may be provided with use of computer equipment and other property of the Corporation. The use and possession of the such items shall be subject to any policies, requirements or restrictions established by the Corporation. Such items may only be used in performance of the Employee's duties for the corporation. On request of the Corporation, the Employee shall immediately deliver any such items to the Corporation. Upon termination of employment, Employee shall have the affirmative duty to return any such item to the Corporation whether a request is made or not. The obligation to return Corporation property shall extend and include any and all work product, client property, proprietary rights, intangible property, and all other property of the corporation regardless of the form or medium. COMPENSATION The Corporation shall pay the Employee such hourly compensation as determined by the Corporation. Payment shall be at the same time as the Corporations usual payroll to other employees. BONUS & BENEFITS Payment of any bonuses shall be at the complete discretion of the Corporation. No guarantee or representation that any bonuses will be paid has been made to the Employee. Standard benefits that are provided to other non-management employees shall be offered to the Employee, subject to the Corporation's policies and the terms and conditions of such benefits. WITHHOLDING All sums payable to Employee under this Agreement will be reduced by all federal, state, local, and other withholdings and similar taxes and payments required by applicable law. QUALIFICATIONS OF EMPLOYEE The employee shall satisfy all of the qualification that are established by the Corporation. TERM OF AGREEMENT There shall be no guaranteed term of employment. Employer acknowledges and agrees that Employee shall be an \"At Will\" Employee and that Employee's employment may be terminated at any time by the Corporation, with or without cause. FEES FROM EMPLOYEE'S WORK The Corporation shall have exclusive authority to determine the fees, or a procedure for establishing the fees, to be charged to clients by the Corporation for services that are provided by the Employee. All sums paid to the Employee or the Corporation in the way of fees, in cash or in kind, or otherwise for services of the Employee, shall, except as otherwise specifically agreed by the Corporation, be and remain the property of the Corporation and shall be included in the Corporation's name in such checking account or accounts as the Corporation may from time to time designate. CLIENTS AND CLIENT RECORDS The Corporation shall have the authority to determine who will be accepted as clients of the Corporation, and the Employee recognizes that such clients accepted are clients of the Corporation and not the Employee. All client records and files of any type concerning clients of the Corporation shall belong to and remain the property of the Corporation, notwithstanding the subsequent termination of the employment. POLICIES AND PROCEDURES The Corporation shall have the authority to establish from time to time the policies and procedures to be followed by the Employee in performing services for the Corporation. This may include, but is not necessarily limited to, employment policies, computer use policies, Internet access policies, email policies, and all other policies, procedures, directives, and mandates established by the Corporation, whether or not in written form or formally adopted. Employee shall abide by the provisions of any contract entered into by the Corporation under which the Employee provides services. Employee shall comply with the terms and conditions of any and all contracts entered by the Corporation. TERMINATION Employee acknowledges and agrees that Employee is an \"at will\" employee of the Corporation. As such, no term of employment is created hereby and employee may be terminated at any time in the sole discretion of the Corporation, whether there exists any cause for termination or not. CREATIONS AND INVENTIONS Employee acknowledges and agrees that any and all work product of the Employee that is conceived or created during the Employee's employment with the Corporation is the exclusive property of the Corporation. This shall include any and all copyrights, trade secrets, confidential information, patents, trademarks, trade dress, ideas, concepts, plans, business plans, business concepts, techniques, inventions, drawings, artwork, logos, graphics, web pages, databases, software, programs, CGI's, plug ins, applications, brochures, inventions, marketing plans and concepts, and all other ideas and work product of the Employee. The Employee acknowledges and agrees that all creations shall be \"works made for hire\" as defined in the [ACT OR CODE]. Notwithstanding the fact that this material may be considered to be a work made for hire, Employee agrees, during Employee's employment and thereafter, which covenant shall survive any termination of the employment relationship, to execute any and all documents requested by the Corporation to confirm the Corporation's ownership and control of all such material, including but not limited to assignments of copyright, confirmations of work for hire status, waivers of proprietary rights, copyright application, and any other documents requested by Corporation. RESTRICTIVE COVENANTS","Employment Agreement_At Will Employee","7","https://templates.business-in-a-box.com/imgs/1000px/employment-agreement_at-will-employee-D541.png","https://templates.business-in-a-box.com/imgs/250px/541.png","https://templates.business-in-a-box.com/svgs/docviewerWebApp1.html?v6#541.xml",{"title":91,"description":6},"employment agreement_at will employee",[93,95,98],{"label":18,"url":94},"human-resources",{"label":96,"url":97},"Hire an Employee","hire-employee",{"label":99,"url":100},"Legal Agreements","business-legal-agreements","/template/employment-agreement_at-will-employee-D541",{"description":103,"descriptionCustom":6,"label":104,"pages":8,"size":9,"extension":10,"preview":105,"thumb":106,"svgFrame":107,"seoMetadata":108,"parents":110,"keywords":109,"url":113},"[DATE] [CONTACT NAME] [ADDRESS] [ADDRESS 2] [CITY, STATE/PROVINCE] [ZIP/POSTAL CODE] SUBJECT: JOB OFFER FOR [DESCRIBE] Dear [CANDIDATE NAME]: Congratulations! [Company name] is excited to offer you the position of [job title] with an expected start date of [day, month, year] at a starting salary of [dollar amount] per [hour, year, etc.]. You can expect to receive payment [weekly, biweekly, monthly, etc.], starting on [date of first pay period]. We must wrap up a few more formalities, including the successful completion of your [background check, drug screening, reference check, etc.]. As the [job title], you will report to [manager/supervisor name and title] at [workplace location] from [hours of day, days of week]","Job Offer Letter Long","https://templates.business-in-a-box.com/imgs/1000px/job-offer-letter-long-D12769.png","https://templates.business-in-a-box.com/imgs/250px/12769.png","https://templates.business-in-a-box.com/svgs/docviewerWebApp1.html?v6#12769.xml",{"title":109,"description":6},"job offer letter long",[111,112],{"label":18,"url":94},{"label":96,"url":97},"/template/job-offer-letter-long-D12769",{"description":115,"descriptionCustom":6,"label":116,"pages":117,"size":118,"extension":10,"preview":119,"thumb":120,"svgFrame":121,"seoMetadata":122,"parents":123,"keywords":128,"url":129},"Employee Handbook Understanding employment at [YOUR COMPANY NAME] Revised on [DATE] Prepared By: [YOUR NAME] [YOUR JOB TITLE] Phone 555.555.5555 Email info@yourbusiness.com www.yourbusiness.com Table of Content Table of Content 2 Welcome to [YOUR COMPANY NAME]! 5 1. Organization Description 6 1.1 Introductory Statement 6 1.2 Customer Relations 6 1.3 Products and Services Provided 7 1.4 Facilities and Location(s) 7 1.5 The History of [YOUR COMPANY NAME] 7 1.6 Management Philosophy 7 1.7 Goals 8 2. The Employment 9 2.1 Nature of Employment 9 2.2 Employee Relations 9 2.3 Equal Employment Opportunity 10 2.4 Diversity 10 2.5 Business Ethics and Conduct 12 2.6 Personal Relationships in the Workplace 13 2.7 Conflicts of Interest 13 2.8 Outside Employment 14 2.9 Non-Disclosure 15 2.10 Disability Accommodation 16 2.11 Job Posting and Employee Referrals 17 2.12 Whistleblower Policy 18 2.13 Accident and First Aid 20 3. Employment Status and Records 21 3.1 Employment Categories 21 3.2 Access to Personnel Files 22 3.3 Personnel Data Changes 23 3.4 Probation Period 23 3.5 Employment Applications 24 3.6 Performance Evaluation 24 3.7 Job Descriptions 25 3.8 Salary Administration 25 3.9 Professional Development 26 4. Employee Benefit Programs 27 4.1 Employee Benefits 27 4.2 Vacation Benefits 27 4.3 Military Service Leave 29 4.4 Religious Observance 29 4.5 Holidays 29 4.6 Workers Insurance 30 4.7 Sick Leave Benefits 31 4.8 Bereavement Leave 32 4.9 Relocation Benefits 33 4.10 Educational Assistance 33 4.11 Health Insurance 34 4.12 Life Insurance 35 4.13 Long Term Disability 35 4.14 Marriage, Maternity and Parental Leave 36 5. Timekeeping / Payroll 40 5.1 Timekeeping 40 5.2 Paydays 40 5.3 Employment Termination 41 5.4 Administrative Pay Corrections 42 6. Work Conditions and Hours 43 6.1 Work Schedules 43 6.2 Absences 43 6.3 Jury Duty 45 6.4 Use of Phone and Mail Systems 45 6.5 Smoking 46 6.6 Meal Periods 46 6.7 Overtime 46 6.8 Use of Equipment 47 6.9 Telecommuting 47 6.10 Emergency Closing 48 6.11 Business Travel Expenses 49 6.12 Visitors in the Workplace 51 6.13 Computer and Email Usage 51 6.14 Internet Usage 52 6.15 Workplace Monitoring 54 6.16 Workplace Violence Prevention 55 7. Employee Conduct & Disciplinary Action 57 7.1 Employee Conduct and Work Rules 57 7.2 Sexual and Other Unlawful Harassment 58 7.3 Attendance and Punctuality 60 7.4 Personal Appearance 60 7.5 Return of Property 61 7.6 Resignation and Retirement 61 7.7 Security Inspections 62 7.8 Progressive Discipline 62 7.9 Problem Resolution 64 7.10 Workplace Etiquette 65 7.11 Suggestion Program 67 Acknowledgement of Receipt 68 Welcome to [YOUR COMPANY NAME]! On behalf of your colleagues, we welcome you to [YOUR COMPANY NAME] and wish you every success here. At [YOUR COMPANY NAME], we believe that each employee contributes directly to the growth and success of the company, and we hope you will take pride in being a member of our team. This handbook was developed to describe some of the expectations of our employees and to outline the policies, programs, and benefits available to eligible employees. Employees should become familiar with the contents of the employee handbook as soon as possible, for it will answer many questions about employment with [YOUR COMPANY NAME]. We believe that professional relationships are easier when all employees are aware of the culture and values of the organization. This guide will help you to better understand our vision for the future of our business and the challenges that are ahead. We hope that your experience here will be challenging, enjoyable, and rewarding. Again, welcome! [PRESIDENT NAME] President & CEO 1. Organization Description 1.1 Introductory Statement This handbook is designed to acquaint you with [YOUR COMPANY NAME] and provide you with information about working conditions, employee benefits, and some of the policies affecting your employment. You should read, understand, and comply with all provisions of the handbook. It describes many of your responsibilities as an employee and outlines the programs developed by [YOUR COMPANY NAME] to benefit employees. One of our objectives is to provide a work environment that is conducive to both personal and professional growth. No employee handbook can anticipate every circumstance or question about policy. As [YOUR COMPANY NAME] continues to grow, the need may arise and [YOUR COMPANY NAME] reserves the right to revise, supplement, or rescind any policies or portion of the handbook from time to time as it deems appropriate, in its sole and absolute discretion. Employees will be notified of such changes to the handbook as they occur. 1.2 Customer Relations Customers are among our organization's most valuable assets. Every employee represents [YOUR COMPANY NAME] to our customers and the public. The way we do our jobs presents an image of our entire organization. Customers judge all of us by how they are treated with each employee contact. Therefore, one of our first business priorities is to assist any customer or potential customer. Nothing is more important than being courteous, friendly, helpful, and prompt in the attention you give to customers. [YOUR COMPANY NAME] will provide customer relations and services training to all employees with extensive customer contact. Customers who wish to lodge specific comments or complaints should be directed to the [TITLE AND NAME OF THE PERSON RESPONSIBLE] for appropriate action. Our personal contact with the public, our manners on the telephone, and the communications we send to customers are a reflection not only of ourselves, but also of the professionalism of [YOUR COMPANY NAME]. Positive customer relations not only enhance the public's perception or image of [YOUR COMPANY NAME], but also pay off in greater customer loyalty and increased sales and profit. 1.3 Products and Services Provided You will find more information about our products and services by reading the [YOUR COMPANY NAME] Corporate Brochures. 1.4 Facilities and Location(s) Head Office: [ADDRESS] [CITY], [STATE] [ZIP/POSTAL CODE] [COUNTRY] 1.5 The History of [YOUR COMPANY NAME] [DESCRIBE THE HISTORY OF YOUR COMPANY HERE] 1.6 Management Philosophy [YOUR COMPANY NAME] management philosophy is based on responsibility and mutual respect. Our wishes are to maintain a work environment that fosters on personal and professional growth for all employees. Maintaining such an environment is the responsibility of every staff person. Because of their role, managers and supervisors have the additional responsibility to lead in a manner which fosters an environment of respect for each person. People who come to [YOUR COMPANY NAME] want to work here because we have created an environment that encourages creativity and achievement. [YOUR COMPANY NAME] aims to become a leader in [DESCRIBE YOUR COMPANY'S FIELD OF EXPERTISE]. The mainstay of our strategy will be to offer a level of client focus that is superior to that offered by our competitors. To help achieve this objective, [YOUR COMPANY NAME] seeks to attract highly motivated individuals that want to work as a team and share in the commitment, responsibility, risk taking, and discipline required to achieve our vision. Part of attracting these special individuals will be to build a culture that promotes both uniqueness and a bias for action. While we will be realistic in setting goals and expectations, [YOUR COMPANY NAME] will also be aggressive in reaching its objectives. This success will in turn enable [YOUR COMPANY NAME] to give its employees above average compensation and innovative benefits or rewards, key elements in helping us maintain our leadership position in the worldwide marketplace. 1.7 Goals [DESCRIBE YOUR COMPANY'S GOALS HERE] 2. 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We will forward your salary earned to date in due course together with any vacation pay to which you are entitled. Within [NUMBER] days of termination we shall issue you a statement of accrued benefits. Any insurance benefits shall continue in accordance with applicable law and/or provisions of our personnel policy. Please contact [Name], at your earliest convenience, who will explain each of these items and arrange with you for the return of any company property. Sincerely, [YOUR NAME] [YOUR TITLE] [YOUR PHONE NUMBER] [YOUREMAIL@YOURCOMPANY.COM] [IF SENT BY EMAIL YOU MAY INCLUDE THIS NOTICE]","Employee Dismissal Letter","2","https://templates.business-in-a-box.com/imgs/1000px/employee-dismissal-letter-D508.png","https://templates.business-in-a-box.com/imgs/250px/508.png","https://templates.business-in-a-box.com/svgs/docviewerWebApp1.html?v6#508.xml",{"title":138,"description":6},"employee dismissal letter",[140,141],{"label":18,"url":94},{"label":142,"url":143},"Employee Termination","employee-termination","/template/employee-dismissal-letter-D508",{"description":146,"descriptionCustom":6,"label":147,"pages":148,"size":149,"extension":10,"preview":150,"thumb":151,"svgFrame":152,"seoMetadata":153,"parents":154,"keywords":158,"url":159},"INDEPENDENT CONTRACTOR AGREEMENT This Independent Contractor Agreement (\"Agreement\") is made and effective [Date], BETWEEN: [INDEPENDENT CONTRACTOR NAME] (the \"Independent Contractor\"), a company organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at: [COMPLETE ADDRESS] AND: [YOUR COMPANY NAME] (the \"Company\"), a company organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at: [YOUR COMPLETE ADDRESS] RECITALS Independent Contractor is engaged in providing [Describe] business services, its Employer Tax I.D. Number is [Insert], and its Business License Number is [insert]. Independent Contractor has complied with all Federal, State, and local laws regarding business permits, sales permits, licenses, reporting requirements, tax withholding requirements, and other legal requirements of any kind that may be required to carry out said business and the Scope of Work which is to be performed as an Independent Contractor pursuant to this Agreement. Independent Contractor is or remains open to conducting similar tasks or activities for clients other than the Company and holds themselves out to the public to be a separate business entity. Company desires to engage and contract for the services of the Independent Contractor to perform certain tasks as set forth below. Independent Contractor desires to enter into this Agreement and perform as an independent contractor for the company and is willing to do so on the terms and conditions set forth below. NOW, THEREFORE, in consideration of the above recitals and the mutual promises and conditions contained in this Agreement, the Parties agree as follows: TERMS This Agreement shall be effective commencing [Date], and shall continue until terminated at the completion of the Scope of Work which shall occur no later than [Date] or by either party as otherwise provided herein. STATUS OF INDEPENDENT CONTRACTOR This Agreement does not constitute a hiring by either party. It is the parties intentions that Independent Contractor shall have an independent contractor status and not be an employee for any purposes, including, but not limited to, [laws]. Independent Contractor shall retain sole and absolute discretion in the manner and means of carrying out their activities and responsibilities under this Agreement. This Agreement shall not be considered or construed to be a partnership or joint venture, and the Company shall not be liable for any obligations incurred by Independent Contractor unless specifically authorized in writing. Independent Contractor shall not act as an agent of the Company, ostensibly or otherwise, nor bind the Company in any manner, unless specifically authorized to do so in writing. TASKS, DUTIES, AND SCOPE OF WORK Independent Contractor agrees to devote as much time, attention, and energy as necessary to complete or achieve the following: [Describe]. The above to be referred to in this Agreement as the \"Scope of Work\". It is expected that the Scope of Work will completed by [Date]. Independent Contractor shall additionally perform any and all tasks and duties associated with the Scope of Work set forth above, including but not limited to, work being performed already or related change orders. Independent Contractor shall not be entitled to engage in any activities which are not expressly set forth by this Agreement. The books and records related to the Scope of Work set forth in this Agreement shall be maintained by the Independent Contractor at the Independent Contractor's principal place of business and open to inspection by Company during regular working hours. Documents to which Company will be entitled to inspect include, but are not limited to, any and all contract documents, change orders/purchase orders and work authorized by Independent Contractor or Company on existing or potential projects related to this Agreement. Independent Contractor shall be responsible to the management and directors of Company, but Independent Contractor will not be required to follow or establish a regular or daily work schedule. Supply all necessary equipment, materials and supplies. Independent Contractor will not rely on the equipment or offices of Company for completion of tasks and duties set forth pursuant to this Agreement. Any advice given Independent Contractors regarding the scope of work shall be considered a suggestion only, not an instruction. Company retains the right to inspect, stop, or alter the work of Independent Contractor to assure its conformity with this Agreement. ASSURANCE OF SERVICES Independent Contractor will assure that the following individuals (the \"Key Employees\") will be available to perform, and will perform, the Services hereunder until they are completed (identify by title and name as applicable): [Name of Key Employee, Title] [Name of Key Employee, Title] The Key Employees may be changed only with the prior written approval of the Company, which approval shall not be unreasonably withheld. COMPENSATION Independent Contractor shall be entitled to compensation for performing those tasks and duties related to the Scope of Work as follows: [Describe] Such compensation shall become due and payable to Independent Contractor in the following time, place, and manner: [Describe] NOTICE CONCERNING WITHHOLDING OF TAXES Independent Contractor recognizes and understands that it will receive a [specify tax] statement and related tax statements, and will be required to file corporate and/or individual tax returns and to pay taxes in accordance with all provisions of applicable Federal and State law. Independent Contractor hereby promises and agrees to indemnify the Company for any damages or expenses, including attorney's fees, and legal expenses, incurred by the Company as a result of independent contractor's failure to make such required payments. AGREEMENT TO WAIVE RIGHTS TO BENEFITS Independent Contractor hereby waives and foregoes the right to receive any benefits given by Company to its regular employees, including, but not limited to, health benefits, vacation and sick leave benefits, profit sharing plans, etc. This waiver is applicable to all non-salary benefits which might otherwise be found to accrue to the Independent Contractor by virtue of their services to Company, and is effective for the entire duration of Independent Contractor's agreement with Company. This waiver is effective independently of Independent Contractor's employment status as adjudged for taxation purposes or for any other purpose. Neither this Agreement, nor any duties or obligations under this Agreement may be assigned by either party without the consent of the other. TERMINATION This Agreement may be terminated prior to the completion or achievement of the Scope of Work by either party giving [number] days written notice. Such termination shall not prejudice any other remedy to which the terminating party may be entitled, either by law, in equity, or under this Agreement. NON-DISCLOSURE OF TRADE SECRETS, CUSTOMER LISTS AND OTHER PROPRIETARY INFORMATION Independent Contractor agrees not to disclose or communicate, in any manner, either during or after Independent Contractor's agreement with Company, information about Company, its operations, clientele, or any other information, that relate to the business of Company including, but not limited to, the names of its customers, its marketing strategies, operations, or any other information of any kind which would be deemed confidential, a trade secret, a customer list, or other form of proprietary information of Company. Independent Contractor acknowledges that the above information is material and confidential and that it affects the profitability of Company. ","Independent Contractor Agreement","6",62,"https://templates.business-in-a-box.com/imgs/1000px/independent-contractor-agreement-D160.png","https://templates.business-in-a-box.com/imgs/250px/160.png","https://templates.business-in-a-box.com/svgs/docviewerWebApp1.html?v6#160.xml",{"title":6,"description":6},[155],{"label":156,"url":157},"Consultant & Contractors","consulting-contractor-business","independent contractor agreement","/template/independent-contractor-agreement-D160",{"description":161,"descriptionCustom":6,"label":161,"pages":8,"size":9,"extension":162,"preview":163,"thumb":164,"svgFrame":165,"seoMetadata":166,"parents":168,"keywords":167,"url":173},"Small Business Expense Report","xls","https://templates.business-in-a-box.com/imgs/1000px/small-business-expense-report-D13396.png","https://templates.business-in-a-box.com/imgs/250px/13396.png","https://templates.business-in-a-box.com/svgs/docviewerWebApp1.html?v6#13396.xml",{"title":167,"description":6},"small business expense report",[169,172],{"label":170,"url":171},"Credit & Collection","credit-collection",{"label":170,"url":171},"/template/small-business-expense-report-D13396",false,{"seo":176,"reviewer":187,"legal_disclaimer":174,"quick_facts":191,"at_a_glance":193,"personas":197,"variants":221,"glossary":248,"sections":279,"how_to_fill":325,"common_mistakes":366,"faqs":383,"industries":411,"comparisons":428,"diy_vs_pro":442,"related_template_ids_curated":455,"schema":468,"classification":470},{"meta_title":177,"meta_description":178,"primary_keyword":15,"secondary_keywords":179},"Employee Request To Participate In Medical Plan Template (Free Word)","Free employee medical plan enrollment request template. Covers employee details, plan selection, dependent coverage, and authorization. Used in 190+ countries. Free Word and PDF download.",[180,181,182,183,184,185,186],"medical plan enrollment form template","employee health insurance enrollment form","medical plan participation request","employee benefits enrollment template","health plan enrollment form word","group health insurance enrollment form","employee medical benefits request form",{"name":188,"credential":189,"reviewed_date":190},"Bruno Goulet","CEO, Business in a Box","2026-05-02",{"difficulty":192,"legal_review_recommended":174,"signature_required":174},"medium",{"what_it_is":194,"when_you_need_it":195,"whats_inside":196},"An Employee Request To Participate In Medical Plan is a standardized enrollment form an employee submits to their employer's HR or benefits department to formally elect coverage under a company-sponsored group health insurance plan. This free Word download captures all the information an HR team needs to process enrollment accurately — from plan tier selection to dependent details — and can be edited online and exported as PDF for filing or digital submission.\n","Use it during new-hire onboarding, at the annual open enrollment period, or whenever a qualifying life event — marriage, birth of a child, or loss of other coverage — triggers a mid-year enrollment window. It ensures every enrollment request is documented in a consistent, auditable format.\n","Employee identification and contact information, plan tier and coverage level selection, dependent enrollment details, prior coverage waiver or coordination of benefits declaration, and the employee's authorization signature confirming the accuracy of the information provided.\n",[198,202,206,209,213,217],{"title":199,"use_case":200,"icon_asset_id":201},"HR managers","Collecting uniform enrollment data from new hires during onboarding","persona-hr-manager",{"title":203,"use_case":204,"icon_asset_id":205},"Small business owners","Documenting employee benefit elections without a dedicated HRIS system","persona-small-business-owner",{"title":207,"use_case":208,"icon_asset_id":201},"Benefits administrators","Standardizing open enrollment submissions across a multi-department workforce",{"title":210,"use_case":211,"icon_asset_id":212},"Payroll specialists","Confirming premium deduction amounts and coverage tiers before processing payroll","persona-accountant",{"title":214,"use_case":215,"icon_asset_id":216},"Operations directors","Establishing a paper trail for benefits elections in compliance with ERISA recordkeeping requirements","persona-operations-director",{"title":218,"use_case":219,"icon_asset_id":220},"Startup founders","Rolling out a group health plan for the first time with a structured enrollment process","persona-startup-founder",[222,226,230,233,237,240,244],{"situation":223,"recommended_template":224,"slug":225},"New hire enrolling in medical coverage during the first 30 days","Employee Request To Participate In Medical Plan","employee-request-to-participate-in-medical-plan-D611",{"situation":227,"recommended_template":228,"slug":229},"Employee waiving medical coverage and documenting the decision","Benefits Waiver Form","benefits-enrollment-form-D13602",{"situation":231,"recommended_template":232,"slug":229},"Employee electing dental and vision coverage separately","Dental and Vision Enrollment Form",{"situation":234,"recommended_template":235,"slug":236},"Employee adding or removing a dependent mid-year due to a qualifying life event","Qualifying Life Event Change Form","change-your-life-by-implementing-these-habits-D13200",{"situation":238,"recommended_template":239,"slug":229},"Employee enrolling in a flexible spending account alongside medical coverage","FSA Enrollment Form",{"situation":241,"recommended_template":242,"slug":243},"Employee changing plan tier during annual open enrollment","Open Enrollment Change Request","change-management-policy-D13822",{"situation":245,"recommended_template":246,"slug":247},"Employer documenting the full benefits package offered to employees","Employee Benefits Summary","employee-salary-and-benefits-cost-breakdown-D366",[249,252,255,258,261,264,267,270,273,276],{"term":250,"definition":251},"Open Enrollment","A fixed annual window during which employees may enroll in, change, or cancel benefit plan elections without a qualifying life event.",{"term":253,"definition":254},"Qualifying Life Event (QLE)","A change in personal circumstances — such as marriage, divorce, birth of a child, or loss of other coverage — that allows an employee to modify benefits elections outside open enrollment.",{"term":256,"definition":257},"Plan Tier","The coverage level selected by the employee, typically: employee only, employee plus spouse, employee plus children, or family.",{"term":259,"definition":260},"Premium","The fixed monthly amount paid to maintain health insurance coverage, usually shared between the employer and employee through payroll deduction.",{"term":262,"definition":263},"Dependent","A spouse, domestic partner, or child under a specified age (typically 26 in the US) who is eligible for coverage under the employee's group health plan.",{"term":265,"definition":266},"Coordination of Benefits (COB)","The process of determining which health plan pays first when an individual is covered by more than one group plan, preventing duplicate payments.",{"term":268,"definition":269},"ERISA","The Employee Retirement Income Security Act, a US federal law that sets minimum standards for employer-sponsored benefit plans including recordkeeping and disclosure requirements.",{"term":271,"definition":272},"COBRA","A US federal law that allows employees and dependents to continue group health coverage for a limited period after employment ends or coverage is otherwise lost.",{"term":274,"definition":275},"Evidence of Insurability (EOI)","Documentation an insurance carrier may require — such as a health questionnaire — before approving coverage above guaranteed-issue limits or outside a standard enrollment window.",{"term":277,"definition":278},"Effective Date","The specific calendar date on which the elected coverage begins, which may differ from the form submission date depending on the plan's administrative rules.",[280,285,290,295,300,305,310,315,320],{"name":281,"plain_english":282,"sample_language":283,"common_mistake":284},"Employee identification","Captures the employee's full legal name, employee ID, job title, department, and date of hire so the form can be matched to the correct personnel record.","Full Name: [EMPLOYEE FULL NAME] | Employee ID: [ID NUMBER] | Job Title: [JOB TITLE] | Department: [DEPARTMENT] | Date of Hire: [MM/DD/YYYY]","Using a nickname or preferred name instead of the legal name on file. Mismatches between the enrollment form and the carrier's records delay coverage activation.",{"name":286,"plain_english":287,"sample_language":288,"common_mistake":289},"Contact and personal information","Records the employee's home address, date of birth, Social Security Number (or equivalent), and personal email address for benefits correspondence.","Home Address: [STREET, CITY, STATE, ZIP] | Date of Birth: [MM/DD/YYYY] | SSN: [XXX-XX-XXXX] | Personal Email: [EMAIL ADDRESS]","Leaving the date of birth blank. Carriers use it to calculate age-banded premiums and to verify dependent eligibility, so an omission stalls processing.",{"name":291,"plain_english":292,"sample_language":293,"common_mistake":294},"Enrollment type","Indicates whether the request is for new enrollment, a qualifying life event change, or the annual open enrollment period, and records the effective date requested.","Enrollment Type: [New Hire / Qualifying Life Event / Open Enrollment] | Qualifying Event (if applicable): [EVENT DESCRIPTION] | Event Date: [MM/DD/YYYY] | Requested Effective Date: [MM/DD/YYYY]","Leaving the enrollment type unselected and relying on HR to infer it from the submission date. Different enrollment types have different deadlines and documentation requirements.",{"name":296,"plain_english":297,"sample_language":298,"common_mistake":299},"Plan selection","Identifies the specific health plan the employee is electing — by plan name and type (HMO, PPO, HDHP) — and the coverage tier chosen.","Selected Plan: [PLAN NAME] | Plan Type: [HMO / PPO / HDHP / EPO] | Coverage Tier: [Employee Only / Employee + Spouse / Employee + Children / Family]","Selecting the plan name without specifying the coverage tier. The tier determines the premium deduction amount — without it, payroll cannot set up the correct deduction.",{"name":301,"plain_english":302,"sample_language":303,"common_mistake":304},"Dependent information","Lists each dependent to be enrolled with their full name, relationship, date of birth, Social Security Number, and whether they have other coverage.","Dependent 1: [FULL NAME] | Relationship: [Spouse / Child / Domestic Partner] | DOB: [MM/DD/YYYY] | SSN: [XXX-XX-XXXX] | Other Coverage: [Yes / No]","Enrolling a dependent without noting that they carry separate coverage. Undisclosed dual coverage creates coordination-of-benefits disputes and can result in overpayments that must later be recovered.",{"name":306,"plain_english":307,"sample_language":308,"common_mistake":309},"Coordination of benefits declaration","Discloses whether the employee or any enrolled dependent is covered under another group health plan, and identifies the other carrier and plan.","Is the employee covered under another health plan? [Yes / No]. If yes — Other Carrier: [CARRIER NAME] | Policy Number: [POLICY NUMBER] | Policyholder: [NAME] | Relationship to Employee: [RELATIONSHIP]","Skipping this section when the employee's spouse carries coverage elsewhere. Missing COB data causes the insurer to pay claims as primary when it should be secondary, creating reconciliation problems months later.",{"name":311,"plain_english":312,"sample_language":313,"common_mistake":314},"Prior coverage waiver or termination confirmation","Documents the termination date of any prior coverage being replaced and confirms the employee is not maintaining overlapping duplicate group coverage.","Prior coverage terminated: [Yes / No] | Prior Carrier: [CARRIER NAME] | Termination Date: [MM/DD/YYYY] | I confirm I am not maintaining duplicate group coverage: [Employee Initials]","Failing to document prior coverage termination when the employee is transitioning from a spouse's plan. The gap — or overlap — in coverage dates can affect COBRA election rights and premium calculations.",{"name":316,"plain_english":317,"sample_language":318,"common_mistake":319},"Payroll deduction authorization","Authorizes the employer to deduct the employee's share of the premium from each paycheck at the stated frequency, and specifies whether pre-tax or post-tax deductions apply.","I authorize [EMPLOYER NAME] to deduct $[AMOUNT] per [bi-weekly / semi-monthly] paycheck for my elected coverage, effective [DATE]. Deduction type: [Pre-Tax (Section 125) / Post-Tax]","Not specifying whether the deduction is pre-tax under a Section 125 cafeteria plan. Post-tax deductions cost the employee more; using the wrong designation affects both take-home pay and annual tax filing.",{"name":321,"plain_english":322,"sample_language":323,"common_mistake":324},"Employee certification and signature","The employee certifies that all information provided is accurate, acknowledges the plan's terms and deadlines, and signs and dates the form.","I certify that the information on this form is accurate and complete. I understand that false information may result in loss of coverage. Signature: [EMPLOYEE SIGNATURE] | Date: [MM/DD/YYYY]","Collecting the form without a dated signature. An undated signature cannot be used to confirm the submission fell within the enrollment window, which creates compliance exposure if the election is later challenged.",[326,331,336,341,346,351,356,361],{"step":327,"title":328,"description":329,"tip":330},1,"Complete employee identification and personal information","Enter the employee's full legal name exactly as it appears on their government-issued ID, along with their employee ID, department, and date of hire. Add date of birth, SSN, and home address.","Cross-reference the employee's onboarding paperwork to confirm the legal name and SSN before submitting — carrier eligibility files are matched on these two fields.",{"step":332,"title":333,"description":334,"tip":335},2,"Select the correct enrollment type and event date","Check the appropriate enrollment type — new hire, qualifying life event, or open enrollment. For a qualifying life event, record the specific event and date, since most plans require submission within 30 days.","Note the plan's deadline for each enrollment type in the form instructions — missing a 30-day new-hire window typically locks the employee out until the next open enrollment.",{"step":337,"title":338,"description":339,"tip":340},3,"Choose the plan and coverage tier","Record the exact plan name as listed in the benefits summary, the plan type (HMO, PPO, HDHP), and the coverage tier. Confirm the employee-only premium versus the family premium before selecting.","Provide a benefits comparison sheet alongside this form so employees can see premium differences between tiers before completing this section.",{"step":342,"title":343,"description":344,"tip":345},4,"List all dependents to be enrolled","For each dependent, enter their full legal name, relationship, date of birth, and SSN. Indicate whether each dependent has other health coverage in force.","Request dependent birth certificates or marriage certificates at the same time — most carriers require documentation within 31 days of enrollment for dependents added outside of new-hire periods.",{"step":347,"title":348,"description":349,"tip":350},5,"Complete the coordination of benefits section","If the employee or any dependent is covered under another group plan, record the other carrier's name, policy number, and the policyholder's relationship to the employee.","Even if the answer is 'no other coverage,' have the employee initial the section — a blank field creates ambiguity during claims processing.",{"step":352,"title":353,"description":354,"tip":355},6,"Document prior coverage termination","If the employee is leaving another plan, record the prior carrier and the exact coverage termination date. Have the employee initial the confirmation that duplicate coverage is not being maintained.","A prior coverage termination date that overlaps with the new effective date by more than a few days should be flagged to the carrier to avoid double-billing.",{"step":357,"title":358,"description":359,"tip":360},7,"Authorize payroll deductions","Enter the per-paycheck deduction amount, payroll frequency, and effective date. Confirm whether the deduction will be processed pre-tax under the employer's Section 125 cafeteria plan.","Verify the deduction amount against the carrier's current rate sheet before the employee signs — rate changes effective at renewal can differ from the prior year's amounts.",{"step":362,"title":363,"description":364,"tip":365},8,"Obtain the employee's dated signature and file the completed form","Have the employee sign and date the certification block. Retain the original in the employee's benefits file and submit a copy to the insurance carrier or benefits broker within the applicable window.","Scan and store the signed form in the employee's digital HR record on the same day — physical forms are easily lost, and the submission date is an auditable compliance record.",[367,371,375,379],{"mistake":368,"why_it_matters":369,"fix":370},"Missing or undated employee signature","An unsigned or undated form cannot prove the submission fell within the enrollment window, creating compliance exposure if a coverage dispute arises later.","Make the signature and date fields mandatory before accepting the form; add a submission-date stamp on receipt.",{"mistake":372,"why_it_matters":373,"fix":374},"Incorrect or missing dependent SSNs","Carriers match dependent eligibility on name plus date of birth plus SSN. Missing SSNs delay the dependent's coverage activation and generate error reports from the carrier.","Collect SSNs for all dependents at the time of enrollment and cross-reference them against the carrier's eligibility confirmation once the enrollment is processed.",{"mistake":376,"why_it_matters":377,"fix":378},"Selecting the wrong coverage tier","Choosing 'employee only' when dependents are being enrolled means the carrier will deny dependent claims until the tier is corrected — a correction that may require retroactive premium adjustments.","Design the form so the plan selection and dependent sections are adjacent, prompting the employee to confirm the tier matches the number of dependents listed.",{"mistake":380,"why_it_matters":381,"fix":382},"Skipping the coordination of benefits section","Undisclosed dual coverage results in the wrong carrier paying primary, triggering overpayment recovery demands months after claims are settled.","Require the employee to complete the COB section for both themselves and each dependent listed, even if the answer is 'no other coverage.'",[384,387,390,393,396,399,402,405,408],{"question":385,"answer":386},"What is an employee request to participate in a medical plan?","It is a standardized enrollment form an employee submits to their employer's HR or benefits department to formally elect coverage under a company-sponsored group health insurance plan. It captures plan selection, coverage tier, dependent details, coordination of benefits disclosures, and payroll deduction authorization in a single auditable document. Without it, the employer has no documented record of the employee's specific elections.\n",{"question":388,"answer":389},"When does an employee need to submit this form?","The form is required in three situations: during the new-hire enrollment window (typically within 30 days of the start date), at the annual open enrollment period, or within 30 days of a qualifying life event such as marriage, birth of a child, adoption, or loss of other coverage. Missing any of these windows generally locks the employee out of coverage changes until the next open enrollment.\n",{"question":391,"answer":392},"What is a qualifying life event and why does it matter?","A qualifying life event (QLE) is a change in personal circumstances recognized by the IRS and the health plan that permits benefit changes outside the annual open enrollment window. Common examples include marriage, divorce, birth or adoption of a child, and loss of coverage under a spouse's plan. Most plans require a completed enrollment form submitted within 30 days of the event date; submissions outside that window are typically rejected.\n",{"question":394,"answer":395},"Does the employee need to submit this form every year?","In most group health plans, elections automatically renew at the same coverage level unless the employee actively changes them during open enrollment. However, employers should still collect a new form whenever plan options change, when an employee's dependent eligibility status changes, or when the carrier requests updated enrollment records. Retaining an annual form for every employee simplifies audits.\n",{"question":397,"answer":398},"What happens if an employee misses the enrollment deadline?","The employee is generally locked out of coverage for the current plan year and must wait for the next open enrollment period. They may still qualify for a special enrollment period if a qualifying life event occurs later in the year. Some employers offer a retroactive enrollment exception for new hires who miss the window due to administrative error, but this requires carrier approval and is not guaranteed.\n",{"question":400,"answer":401},"Are dependents automatically enrolled when an employee enrolls?","No. Each dependent must be explicitly listed on the enrollment form with their name, date of birth, SSN, and relationship. Selecting a family coverage tier without completing the dependent section does not automatically add dependents to the carrier's eligibility file. Most carriers also require supporting documentation — birth certificate or marriage certificate — within 31 days of enrollment.\n",{"question":403,"answer":404},"Does this form need to be notarized or witnessed?","No notarization or independent witness is required for a standard group health plan enrollment form. The employee's dated signature certifying the accuracy of the information is sufficient. Some carriers require an HR representative's counter-signature to confirm eligibility, but this is an internal administrative step rather than a legal formality.\n",{"question":406,"answer":407},"How long should employers retain completed enrollment forms?","Under ERISA, employers are generally required to retain plan records for a minimum of six years from the date of filing. Many HR teams retain enrollment forms for the duration of the employee's tenure plus six years after separation. Storing signed forms in a secure digital HR system rather than paper files reduces retrieval time and protects against physical document loss.\n",{"question":409,"answer":410},"Can this form be submitted electronically?","Yes. Many employers process enrollment requests through an HRIS or benefits administration platform where employees complete the equivalent fields digitally. When using a Word-based template, the completed form can be exported as PDF, signed electronically, and submitted by email or uploaded to the HR system. The key requirement is retaining a time-stamped record of the submission.\n",[412,416,420,424],{"industry":413,"icon_asset_id":414,"specifics":415},"Professional Services","industry-professional-services","High employee-to-HR ratio means standardized forms reduce the administrative burden of processing enrollment for multiple staff members simultaneously during annual open enrollment.",{"industry":417,"icon_asset_id":418,"specifics":419},"Retail and Hospitality","industry-retail","High turnover and part-time eligibility thresholds make it critical to document exactly when each employee met hours requirements and formally requested coverage.",{"industry":421,"icon_asset_id":422,"specifics":423},"Manufacturing","industry-manufacturing","Union and non-union workforce splits require separate plan options and enrollment windows that must be tracked independently on a per-employee basis.",{"industry":425,"icon_asset_id":426,"specifics":427},"Healthcare","industry-healthtech","Regulatory scrutiny of employee benefit administration means complete, signed enrollment records are essential for ERISA compliance audits and accreditation reviews.",[429,432,435,438],{"vs":228,"vs_template_id":430,"summary":431},"D{BENEFITS_WAIVER_ID}","A benefits waiver form documents an employee's decision to decline medical coverage — typically because they are covered under a spouse's or parent's plan. An enrollment request documents the decision to accept coverage. Both are needed to maintain a complete benefits election record for every employee in the workforce.",{"vs":246,"vs_template_id":433,"summary":434},"D{BENEFITS_SUMMARY_ID}","A benefits summary describes what the employer offers — plan options, premium contributions, and eligibility rules. An enrollment request is the employee's response — their formal election of a specific option. The summary informs the decision; the enrollment form documents it.",{"vs":242,"vs_template_id":436,"summary":437},"D{OPEN_ENROLLMENT_ID}","An open enrollment change request is used to modify existing coverage elections during the annual window — changing plan tier, adding or removing dependents, or switching plan types. An initial enrollment request is for first-time participation. Both use similar data fields but serve different administrative purposes and trigger different effective dates.",{"vs":439,"vs_template_id":440,"summary":441},"New Employee Onboarding Checklist","D{ONBOARDING_CHECKLIST_ID}","An onboarding checklist tracks all the administrative tasks required when a new hire joins — including completing benefit enrollment forms — but does not itself document the benefit election. The medical plan enrollment form is a specific deliverable within the broader onboarding process, and both documents should be retained in the employee's file.",{"use_template":443,"template_plus_review":447,"custom_drafted":451},{"best_for":444,"cost":445,"time":446},"SMBs and HR generalists managing group enrollment without a dedicated benefits administration platform","Free","5–10 minutes per employee",{"best_for":448,"cost":449,"time":450},"Employers adding custom plan options, multi-carrier elections, or FSA/HSA coordination fields","$100–$300 (HR consultant or benefits broker review)","1–2 days",{"best_for":452,"cost":453,"time":454},"Large employers with self-funded plans, complex eligibility rules, or multi-state workforces requiring carrier-specific enrollment data formats","$500–$2,000 (benefits administration specialist)","1–2 weeks",[456,457,458,459,460,461,462,463,464,465,466,467],"employment-agreement_at-will-employee-D541","job-offer-letter-long-D12769","employee-handbook-D712","employee-dismissal-letter-D508","independent-contractor-agreement-D160","small-business-expense-report-D13396","risk-register-D14096","how-to-review-employee-performance-D12595","checklist-new-employee-onboarding-D13617","remote-work-agreement-D13282","non-disclosure-agreement-nda-D12692","interview-guide-human-resources-manager-D11593",{"emit_how_to":469,"emit_defined_term":469},true,{"primary_folder":94,"secondary_folder":471,"document_type":472,"industry":473,"business_stage":474,"tags":475,"confidence":480},"benefits-and-perks","form","general","all-stages",[476,472,477,478,479],"benefits","hr","health-insurance","enrollment",0.95,"\u003Ch2>What is an Employee Request To Participate In Medical Plan?\u003C/h2>\n\u003Cp>An \u003Cstrong>Employee Request To Participate In Medical Plan\u003C/strong> is a standardized enrollment form that an employee submits to their employer's HR or benefits department to formally elect coverage under a company-sponsored group health insurance plan. It captures the employee's personal and dependent information, plan selection, coverage tier, coordination of benefits disclosures, and payroll deduction authorization in a single document that creates an auditable record of the election. By formalizing the enrollment decision in writing, the form protects both the employer and the employee — ensuring that coverage elections are processed accurately, premiums are deducted correctly, and the submission date is documented in case an enrollment window is ever disputed.\u003C/p>\n\u003Ch2>Why You Need This Document\u003C/h2>\n\u003Cp>Without a completed enrollment form on file, HR teams have no documented evidence of what plan an employee elected, when they requested it, or whether dependents were intentionally added or inadvertently omitted. Verbal or email-based elections are difficult to enforce when a carrier questions eligibility, a claim is denied for a dependent not on file, or an employee disputes the premium deduction amount appearing in their paycheck. Under ERISA, employers operating group health plans are required to maintain adequate plan records — a signed enrollment form satisfies that obligation for each participant. This template gives HR teams a consistent, complete document to collect at every enrollment trigger event: new hire onboarding, annual open enrollment, and qualifying life event changes. Using it from day one eliminates the gaps that create compliance exposure and claims processing delays.\u003C/p>\n",1781186027074]