Consent of Employee to be Monitored and Recorded
for Security Purposes Pursuant to Closed-Circuit Video Surveillance
Whereas, (Name of Employer), a corporation organized and existing under the laws of
the state of (name of state), with its principal office located at (street address, city, state,
zip code), referred to herein as hereinafter referred to as Employer, owns and operates
a (e.g., business, factory, plant) located at (street address, city, county, state, zip code),
hereinafter called Premises; and
Whereas, (Name of Employee) hereinafter referred to as Employee, either desires to
be employed by or is employed by Employer on Premises; and
Whereas, Employee recognizes the need for closed-circuit video surveillance on and
about Premises for security and productivity purposes; and
Whereas, Employee recognizes and agrees that it is a condition of employment and/or
continuing employment with Employer that Employee freely execute and agree to this
closed-circuit video surveillance, included being personally recorded pursuant to said
closed-circuit video surveillance;
Now, therefore, for and in consideration of employment with Employer, and other good
and valuable