Remote Work Waiver and Liability Release

Remote Work Waiver and Liability Release
Please complete this form to acknowledge your agreement to the terms and conditions for remote work, including the waiver of certain liabilities.
Full Name
First NameLast Name
Job Title
Department
Work Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Remote Work Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Equipment Provided by Company (select all that apply)
Other
I acknowledge that I have read and understand the company's remote work policy.
Signature
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