About his experience - American College of Gastroenterology

Enki Health and Research Systems, Inc.
Consensual Romantic Relationship Agreement Form
LOCATION ___________________________
THIS FORM IS TO BE COMPLETED & SIGNED WHEN AN EMPLOYEE BEGINS A
CONSENSUAL ROMANTIC RELATIONSHIP WITH A CO-WORKER OR BEGINS WORK
AND IS ALREADY INVOLVED IN A ROMANTIC RELATIONSHIP.
I, ______________________________________ hereby acknowledge that I am involved in a
Print Employee Name
Consensual romantic relationship with ______________________________ at ______________.
Print Employee Name
Site
Print Form
By initialing the following I acknowledge;
_______I have reviewed the Personal Conduct with Clients, Staff and Visitors Policy (P-609) and;
_______I do not have a Supervisor/Subordinate relationship;
_______This relationship is voluntary;
_______I have reviewed the Sexual Harassment Policy (P-920) and will abide by the policy;
_______I will behave professionally at work;
_______The relationship will not affect work; and
_______I will not engage in offensive workplace behavior.
_________________________________
Signature of Employee
__________________________________
Date
_________________________________ APPROVED: _________________________________
Supervisor
Clinic Manager
==========================================================================
This form must be completed by each employees involved in the consensual relationship. A copy of
this form must be placed in the CONFIDENTIAL file of each employee and the original sent to the
Human Resource Administrator at the Corporate Office.
______________________________________
Corporate Staff (Print Name)
______________________________________
Signature
Per 114 Consensual Relationship Agreement Form (Revised 01/04/06)
________________________________
Date
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