Acknowledgement and Waiver Regarding Employee Dating
(One Acknowledgement is to be completed by each Employee)
This Agreement made this (date) by (Name of Male Employee) of (street address, city,
state, zip code), in favor of (Name of Company), hereinafter called the Company.
WHEREAS, a concern has been expressed by the Company regarding the personal
relationship which has occurred between (Name of Male Employee) and (Name of Female
WHEREAS, the Company, on its behalf as well as that of its employees, is concerned
regarding any potential for legal exposure which may arise out of said relationship; and
WHEREAS, (Name of Male Employee) and (Name of Female Employee) wish to provide
assurances to the Company and its employees, as consideration for continued employment and
in lieu of transfer, termination, or other action;
The undersigned (Name of Male Employee) hereby acknowledges:
1. As of the day of the signing of this Agreement, I, (Name of Male Employee),
have entered into a voluntary relationship with (Name of Female Employee).
2. I have not requested, nor do I expect favoritism from (Name of Female Employee) or the
Company as related to my working relationship.
3. I am not aware of any conflicts related to my relationship with (Name of Female
4. As of the present date I am not aware of any conduct that I would consider to be
wrongful on the part of the Company, (Name of Female Employee), the employees of the
Company, and I waive any claim potentially related to same.
5. Should at any time I cons