ACKNOWLEDGMENT OF WORK RULES

Employee name:

Employee number:

Department:

Social Security number:

I have read and understand the company work rules. I acknowledge

that I am expected to conform to those rules and that I am

subject to termination for failure to conform to the said rules.

It is understood that any modification to the work rules must be

in writing and signed by [individual with the authority to

modify work rules]. In addition, I acknowledge that I have a

duty to report to [supervisor] any violations of the work rules

by other employees.

Acknowledged by:

Date: