New Employee Paperwork Summary - Intel · New Employee Paperwork Summary ... APPENDIX A TO EMPLOYMENT AGREEMENT SECTION 5 Employee Name: ... “Yes” for patents which your former
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New Employee Paperwork Summary
EMPLOYEE NAME __________________________________ WWID _____________________
Completed by New Hire
1. Appendix A / Employment Agreement
2. Information Supplement 1
3. Information Supplement 2
4. Code of Conduct Questionnaire
5. Intel Employee Agreement
6. New Employee Orientation Certification
7. Intel Retirement Plans Prior Service Questionnaire
Do you own or control, in whole or in part, any Preexisting Employee Intellectual Property
(including patents and patent applications) that you are not licensing to the Intel Group, as
defined in Section 5 as Identified Employee Controlled Intellectual Property? (Do not answer
“Yes” for patents which your former employer or other party owns, but which merely name
you as an inventor.)
If yes, list such Identified Employee Controlled Intellectual Property (attach or specifically identify
relevant patents, patent applications, or similar disclosures):
Do you have an economic interest in any patents, pending applications or other Preexisting
Employee Intellectual Property that you do not own or control, for example patents or
applications owned by a University on which you are named an inventor?
If yes, list such Preexisting Employee Intellectual Property (attach or specifically identify relevant
patents, patent applications, or similar disclosures):
Attach additional sheets as necessary. Number of additional sheets attached: ____
Employee Signature: ___________________________
Date:_______________
Information Supplement
PLEASE PRINT
Complete all requested information. All information you provide will be handled in strict confidence.
EMPLOYEE NAME: ___________________________________________________________________________ LAST FIRST MIDDLE WORLDWIDE ID: ____________________SOCIAL SECURITY NUMBER: _____-____-______
HOME PHONE NUMBER: _______________________________________________________ EMERGENCY CONTACT: _______________________________________________________ NAME RELATIONSHIP PHONE NUMBER
Technology Transfer Control Information Intel works in technology areas that are subject to export controls by the United States government. Intel
must obtain authorization from the Bureau of Industry and Security, U.S. Department of Commerce, before
employing citizens from certain countries. This questionnaire is designed to assist Intel in determining
whether it must apply for an export license on behalf of a potential new hire. QUESTION 1 As of today’s date, are you one of the following:
• Citizen or Legal National of the United States; • Lawful Permanent Resident (PR) of the United States (Note: Only having an application for PR status
pending requires a “NO” answer.) • A person granted refugee status in the United States (Note: Only having public interest parole,
humanitarian parole, or temporary protected status requires a “NO” answer.) • A person granted asylum status in the United States (Note: Only having an asylum application
pending requires a “NO” answer)
□ YES □ NO
NOTE: Individuals in nonimmigrant visa status such as B, L, H visa status should answer NO. QUESTION 2 If your answer to Question 1 is “NO”, but you claim that you have authorization to work in the United States
on a full-time basis, please identify the basis for your right to work in U.S:
Check, if applicable: □ Optional Practical Training □ Curricular Practical Training (If you checked either box, bring a copy of the I-20 form to NEO)
QUESTION 3 If your answer to Question 1 is “NO” to all the legal status categories, please answer the following:
• What is your citizenship? ___________________________________________________ • If you have multiple citizenship (i.e., citizenship in two or more countries), name the country in
which you have the most recent citizenship and provide the citizenship issuance date. ________________________________________________________________________
• If you have Permanent Residency (PR) in multiple countries (i.e., PR in two or more countries),
name the country in which you have the most recent PR and provide the PR issuance date. ________________________________________________________________________
I understand that any work assignment at Intel may be conditioned upon export license requirements
I CERTIFY THAT THE INFORMATION SUPPLIED IS TRUE AND CORRECT ___________________________________________________ _________________________________ EMPLOYEE SIGNATURE DATE Rev. 11/2010
Information Supplement, page 2 The following information is required for
confirmation of employment and/or benefit status:
EMPLOYEE NAME ________________________________
DATE OF BIRTH ___/____/____
MARITAL STATUS: □ SINGLE □ MARRIED GENDER: □ MALE □ FEMALE
expression, or sexual orientation. This principal applies to all areas of employment: recruitment and hiring,
training, performance evaluations, promotions and transfers, compensation and benefits, and social and
recreational programs. We encourage and invite you to complete the information below. Your information is critical to our efforts in
complying with federal and state Equal Employment Opportunity record keeping, reporting, and other legal
requirements. While identifying is voluntary, Intel will also use this information to invite you to applicable
Intel events and related communications. Any information you provide will be kept confidential and will be
used only in accordance with legal requirements
What is your race? Please select all that apply. You may also select one race or ethnicity category that you
most closely identify with as primary:
□
Hispanic, Latino, or of Spanish Origin - A person having origins in any of the original
peoples of Cuba, Mexico, Puerto Rico, South or Central America, or other Spanish
culture or origin regardless of race.
□
American Indian or Alaska Native - A person having origins in any of the original
peoples of North and South America (including Central America), and who
maintain tribal affiliation or community attachment.
□
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
□
Black or African American - A person having origins in any of the black racial groups
of Africa.
□
Native Hawaiian or Other Pacific Islander - A person having origins in any of the
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
□
White - A person having origins in any of the original peoples of Europe, the Middle
East, or North Africa.
HAVE YOU EVER SERVED IN THE U.S. MILITARY (ACTIVE, RESERVE, AND/OR NATIONAL GUARD?)
If YES the below is all about you.
Intel welcomes military veterans, active duty, and guard and reserves! We value your experience and know that the
military shares our values: discipline, quality, risk taking, results orientation, customer orientation, and great place to work.
More than simply words, they are something we live by each day. They speak to everyone within our diverse workforce,
and service members who have lived and breathed these values will do well at Intel. If you have served in the military, we
invite you to identify yourself below as a proud member of this community. Identifying your military status is voluntary
but it provides Intel with critical, relevant, and accurate data on our workforce which translates into enhanced results in
recruiting, retaining, promoting, and supporting our military employees. As a part of Intel’s military community, you can
choose to be involved in additional events, help build programs, and foster ongoing efforts.
Please check which category you fall into:
□
ACTIVE DUTY WARTIME OR CAMPAIGN BADGE VETERAN: You served on active duty in the U.S.
military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
□
NATIONAL GUARD OR RESERVE SERVICE: You are serving or served in the National Guard or Reserve but
were not called or drafted into active service by the U.S.
In addition, please check all that are applicable (you may check more than one category):
□
DISABLED MILITARY/VETERAN: You (a) were discharged or released from active duty because of a
service-connected disability, or (b) are entitled to compensation under laws administered by the
Secretary of Veterans Affairs.
□
RECENTLY SEPARATED MILITARY/VETERAN: You served on active duty within the last 3 years.
the disclosure of such personnel information is permissible under local labor law such as the right of
employees to discuss compensation and working conditions under the US National Labor Relations
Act), and other non-public Intel data and information of a similar nature. I understand and agree that
all Confidential Information that I acquire in connection with my Intel employment is Intel’s exclusive
property. I agree to return to Intel all of its Confidential Information (hard or soft copies; originals
and copies) as well as all devices and equipment belonging to Intel (including computers, handheld
electronic devices, telephone equipment and other electronic devices) either at the termination of
my Intel employment or upon Intel’s request. I agree that any violation of this provision will result in
immediate and irreparable injuries and harm to Intel, and that Intel shall have the option of pursuing
all available legal and equitable remedies, including injunctive relief and specific performance.
4. Ownership of Proprietary Developments. Except as provided in the next sentence, I agree that all trade secrets, copyrights, mask works,
trademarks, inventions (including service inventions), discoveries, designs, formulae, processes,
methods, manufacturing techniques, improvements, ideas, copyrightable works, and other
intellectual property which I create, invent or discover alone or with others during my Intel
employment, (collectively “Proprietary Developments”) are Intel’s sole property from the moment of
their creation, invention or discovery. This shall not apply to an invention that I develop entirely on
my own time without using Intel equipment, supplies, facilities, or trade secret information, except
for those inventions that either: (1) relate at the time of conception or reduction to practice of the
invention to Intel business, or actual or demonstrably anticipated research or development of Intel;
or (2) result from any work performed by me for Intel. I agree that Intel has and shall always have
sole legal and equitable title to all Proprietary Developments. Further, I have no right to compensation for such Proprietary Developments unless
otherwise provided for by applicable law. I agree to promptly disclose Proprietary Developments to Intel, and
to the full extent allowed by law, but only to the extent not already owned by Intel pursuant to this
Agreement and applicable law, hereby assign to Intel all rights in the Proprietary Developments. I
agree that during and after my employment with Intel I will provide all assistance that Intel
reasonably requests to secure or enforce its rights throughout the world with respect to Proprietary
Developments, including signing all necessary documents to secure or memorialize those rights. If I
fail or refuse to sign documents necessary to secure or enforce Intel’s rights, or if Intel cannot
locate me through the exercise of reasonable diligence, I irrevocably appoint Intel or its designee as
my attorney to sign such documents in my name. I waive any rights that I may have in any
Proprietary Developments and, to the extent that such waiver is ineffective under applicable law
until a Proprietary Development is created, invented or discovered, I agree to waive such rights
immediately upon the creation, invention or discovery of such Proprietary Development.
5. Licensed and Non-Licensed Preexisting Employee Intellectual Property. As used in this Agreement “Preexisting Employee Intellectual Property” means intellectual property
that I created prior to my employment with Intel.
I have specifically listed in Appendix A all Preexisting Employee Intellectual Property that I, in whole
or in part, own or control, or have the right to license and intend to exclude from licensing to Intel
I have also listed in Appendix A all Preexisting Employee Intellectual Property in which I have an
economic interest (but do not own or control) and for which I do not have the right to grant a license
to Intel.
For the avoidance of doubt, I agree that any Preexisting Employee Intellectual Property that I, in
whole or in part, own, control or have the right to license and that is neither Identified Employee
Controlled Intellectual Property nor identified in Appendix A prior to my employment in sufficient
detail to Intel to identify its subject matter is licensed to Intel in the same manner and scope as
disclosed or used Identified Employee Intellectual Property.
I agree that if I fail to make any required disclosure or breach any term of Sections 4 and 5, any
applicable limitations periods shall be tolled and shall not run as to any claim, right, or cause of
action Intel may have relating to such disclosure or breach that would have been discovered had
the required disclosure been made, until such time as Intel obtains actual knowledge of the facts
giving rise to such claim. Nothing contained in this Section shall limit other remedies otherwise
available in law or in equity to Intel.
6. Non-solicitation and Misappropriation of Intel Trade Secrets. Intel’s Confidential Information includes confidential and private information relating to other
employees and customers. Additionally, Intel has a legitimate business interest in its continuing
employment and customer relationships and in protecting those relationships from unlawful
interference. Accordingly, I agree that for twelve (12) months after my employment ends, I will not
solicit, directly or indirectly, any employee to leave his/her employment with Intel. This applies to
any employees that were employed with Intel as of my separation date from the company and with
whom I had business contact or about whom I had access to Confidential Information during my
previous two years of employment with Intel prior to my separation. I further agree that I shall not
use or disclose Intel Confidential Information on behalf of myself or to aid any third party to target,
identify, and/or solicit Intel customers or Intel employees to leave Intel employment and/or
misappropriate Intel trade secrets. I agree that any violation of this provision will result in
immediate and irreparable injuries and harm to Intel, and that Intel shall have the option of pursuing
all available legal or equitable remedies, including injunctive relief and specific performance. I
understand that nothing in this Agreement prohibits me from disclosing my compensation
information to third parties in accordance with applicable law.
7. Computer Communications Are Not Private.
I acknowledge that use of Intel’s computer systems is not private or confidential. I understand and
consent to Intel’s right to review any communications to or from my work computer, pager, phone or
other electronic device and all computer information, including any password-protected employee
communications, in accordance with applicable law.
8. At-will Employment (U.S. only) I acknowledge that my employment with Intel is “at-will” which means that both Intel and I have the
right to terminate my employment at any time, with or without advance notice and with or without
cause. I understand that if I become employed by an Intel entity outside the U.S., local employment
and termination law will apply if inconsistent with this Agreement.
9. Miscellaneous. I understand that if Intel Corporation is not my employer, Intel Corporation is signing this Agreement
as agent for the Intel Corporation subsidiary, affiliate or successor that is my employer. The
Agreement’s terms and conditions are severable. If any part of this Agreement is found or held to
be unenforceable in any jurisdiction in which this Agreement is being performed, such provision
shall be enforced to the greatest extent permitted by law, and the remainder of this Agreement and
such provision as applied to other persons, places or circumstances shall remain in full force and
effect. This Agreement: (a) survives my employment with Intel; (b) inures to the benefit of successors and assigns of Intel; and (c) is binding upon my heirs,
assigns, and legal representatives. I am not a party to any other agreement which will interfere with
my full compliance with this Agreement, except as I have specifically identified in this Agreement.
For U.S. employees, only a written agreement, signed by the Vice-President, General Manager of
Human Resources can change the “at will” nature of your employment. The remainder of this
Agreement may not be modified or amended except in writing, signed by the parties. Only the Vice
President, General Manager of Human Resources for Intel Corporation, or the General Counsel of
Intel Corporation, or their delegate, has the authority to sign an Agreement modifying the remainder
of this Agreement on behalf of Intel. This Agreement is effective the first day of my employment with
Intel, and supersedes any prior employee agreement signed by me with Intel, relating to this subject
matter. I have carefully read all of the provisions of this Agreement and I understand and will fully
and faithfully comply with all provisions.
Intel Corporation
Steve Rodgers, Signature General Counsel
Employee
__________________________________/___________________ Printed Name & WWID # (please print clearly)
_____________________________
Signature Date
Intel updated Rev. 1/2016
New Employee Orientation Certification
I, ______________________________, acknowledge receipt of the Intel Code of
Conduct, Information Security Business Code of Conduct and other employee
materials. In addition to these documents, I understand that the Intel Employment
Guidelines provide a framework for workplace conduct and expectations. The Intel
Employment Guidelines cover:
About the Intel Employment Guidelines: Equal Employment Opportunity and
Important Information Diversity
Alcohol and Drug-Free Workplace
Non-Fraternization Anti-harassment Open Door
Attendance at Work
Progressive Discipline Conducting Outside Business Security and
Confidential Information Electronic Communications Solicitation, Distribution and Information-Posting
Employee Records and Information Requests Workplace Behavior/Discipline and Discharge
Employment at Will Workplace Threats and Violence
I understand that I am expected to read and comply with the Intel Employment Guidelines
which can be found on Circuit (Intel’s internal website) under the My Life & Career Tab / My
Career / Intel Employment Guidelines. I acknowledge my obligation to review the Intel
Employment Guidelines within the first three weeks of my employment.
I understand and agree that nothing in the Intel Employment Guidelines, Code of Conduct,
Information Security Business Code of Conduct or other policies create an employment
contract or other express contractual obligations on the part of Intel. I also understand
that Intel reserves the right to add, modify, or delete provisions set out in these policies
and guidelines at any time without advance notice. I understand and agree that my
employment is at will which means that either Intel or I have the right to terminate my
employment at any time, with or without advance notice and with or without cause. Only
a written agreement, signed by the Vice-President and Director of Human Resources, can
change the at-will nature of my employment.
I certify that I have read and understand the above.
PRINTED NAME EMPLOYEE SIGNATURE WORLDWIDE ID DATE Intel updated Rev 11/2014
The Intel Retirement Plans
Prior Service Credit Questionnaire
New employees who have previously worked at an Intel Subsidiary in a contingent worker assignment as
an employee of a temporary employment or service agency may be eligible for Prior Service Credit
under the Intel Retirement Plans. Intel Subsidiaries include (but not limited to) McAfee, WindRiver,
Havok.
This questionnaire should be used for prior service only.
If you cannot answer “Yes” to ALL of the below questions, you are not eligible for Prior
Service Credit and should not complete or submit this questionnaire.
Yes No I have performed service for an Intel Subsidiary while working as an employee of another
company e.g. employment or temporary agency (i.e.:
Kelly Services, etc). NOTE:
- Independent contractors should answer
“No”
- Individuals employed directly for a company acquired by Intel should answer “No”
Yes No While working as an employee of another company (contingent worker), I reported to and was directly managed in my daily activities by an Intel Subsidiary employee during the entire 365 day period.
Yes No
I worked for an Intel Subsidiary service agency or
supplier for a minimum of 12 consecutive
(unbroken) months within the five years
prior to my most current Intel Hire or Rehire
date
If you answered “Yes” to ALL of the above questions, please complete remaining
information below, sign, scan and send this form to: [email protected]
Your answers will help us verify (if required, you can provide proof of your eligibility information by W2
or other means) and set up your eligibility for Prior Service Credit under the Intel Retirement Plans. Prior
Service Credit will be used to determine when you are eligible to participate in the Plans, and when
future Intel contributions may be made and will vest on your behalf.
Prior Service Credit Employee Eligibility Information
Please provide the following information regarding your employment with the temporary agency or
service agency.
If you have worked for more than one agency, please use the back of this form for additional agency
information.
Incomplete forms will not be processed
Agency Name: _____________________________________________ (example: Kelly Services)
Address: ______________________________________________________________ (street, city,
state, zip) Area Code and Phone #: _____________ Agency Contact Name: __________________________
Agency Employment Dates: From __ __ - __ __ - __ __ to __ __ - __ __- __ __
*Dates must include full MM-DD-YY or they will not be processed
Description of service you provided while an employee of this agency:
_________________________________________________________________________ Name of
Intel Subsidiary employee who managed you: ___________________________ Describe how you
Welcome to Intel, Part of getting started at Intel is to make critical benefits decisions for you and your family. If you are eligible, you are automatically enrolled in the benefits described under Default Coverage below from your date of hire (except for Interns who default to no coverage). No action is required by you unless you wish to select different plan options, waive (no coverage) coverage for yourself, or enroll your eligible dependents.
To research your options, costs, or to begin the enrollment process visit the My Health Benefits Web site; from Circuit, search for My Health Benefits or from the Internet at www.intel.com/go/myben.
As a new hire I understand that: √ I must take action within 30 days of my start date to either enroll or waive benefits for myself and any
eligible dependents or I will be defaulted into the coverage described below. The next opportunity to change my benefits will be during annual enrollment or if I experience a change-in-
status event (e.g., marriage, birth of a child). Enrollment for any change-in-status event must be completed within 30 days of the date of the event.
√ I must select the same medical and dental plan for my dependents as I do for myself. √ The coverage I select will take effect back to my hire or rehire date.
I understand that my decision not to take action will result in the Default Coverage below:
√ I will be automatically enrolled in the Default Coverage which is the employee only coverage for medical (Anthem Blue Cross High Deductible Health Plan) at a cost of $0 per month, dental (Delta Dental) at a cost of $2.00 per month and basic vision plan (VSP) for $1.00 per month (except for Interns, who will default to no coverage)
You can change this default coverage by accessing the My Health Benefits Web site within the first 30 days from your hire or rehire date.
√ Short-Term Disability (STD): STD provides financial assistance if I am unable to work due to illness, injury, or pregnancy. NOTE: CA, NJ, NY, RI and HI make enrollment in STD mandatory.
If I live in CA, I will automatically be enrolled in the Intel California Voluntary Short Term Disability Plan (CA-VSTD) at a cost of 0.8% of wages to an annual maximum of $650.00. I understand I will be allowed to change to the CA state disability insurance plan (CA-STD) at a higher cost (1.0% of wages to an annual maximum of $1016.36), but will not be allowed to completely opt out of all plans. NOTE: The CA-VSTD provides richer coverage at a lower cost than the CA-SDI plan.
If I live in HI, I will be automatically enrolled in my state disability plan. I further understand that I will be auto-enrolled in the Intel STD plan as supplement coverage at a combined state STD Plan and Intel STD Plan cost of 0.8% of wages to an annual maximum of $604.68. You can only waive the supplemental
default coverage by accessing the My Health Benefits Web site within the first 30 days from your hire or rehire date.
If I live in NJ, I will be automatically enrolled in my state disability plan. I further understand that I will be auto-enrolled in the Intel STD plan as supplement coverage at a combined state STD Plan and Intel STD Plan cost of 0.9% of wages to an annual maximum of $608.46. You can only waive the supplemental default coverage by accessing the My Health Benefits Web site within the first 30 days from your hire or rehire date.
If I live in NY, I will be automatically enrolled in my state disability plan. I further understand that I will be auto-enrolled in the Intel STD plan as supplement coverage at a combined state STD Plan and Intel STD Plan cost of 0.8% of wages to an annual maximum of $600. You can only waive the supplemental default coverage by accessing the My Health Benefits Web site within the first 30 days from your hire or rehire date.
If I live in RI, I will be automatically enrolled in my state disability plan at a cost of 1.2% of wages to an annual maximum of $752.40. You cannot waive this coverage.
If I live in any state not mentioned above, I will be automatically enrolled in the Intel STD plan at a cost of 0.8% of wages to an annual maximum of $600. You can waive this default coverage by accessing the My Health Benefits Web site within the first 30 days from your hire or rehire date.
I understand the cost of medical, dental and disability coverage noted above are 2014 rates and are subject to change. Notice of Special Enrollment Rights If you are waiving enrollment in the Intel Group Health Plan for yourself or your dependents (spouse and children) because of other health insurance coverage, you may in the future be able to enroll yourself and your dependents in the Intel Group Health Plan provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependent provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Additionally, you may be able to enroll yourself and your dependents in the Intel Group Health Plan under these additional two scenarios:
You or your dependent(s) Medicaid or Children’s Health Insurance Program (“CHIP”) coverage is terminated as a result of
loss of eligibility. You must request this special enrollment for you and your dependent(s) within 60 days of the loss of coverage for Medicaid or CHIP.
You or your dependent(s) become eligible for a premium assistance subsidy* under Medicaid or CHIP. You must request
this special enrollment within 60 days of when eligibility for the premium assistance subsidy is determined.
* Note: States may elect to provide premium assistance subsidies to eligible, low-income children under a qualified employer-sponsored group health plan by reimbursing employees for the difference in cost between the state plan and the employer’s plan. The Health FSA, CIGNA HDHP, and Anthem Blue Cross HDHP are not considered a qualified employer sponsored group health plan. ___________________________ ______________________________ _______________ ___________
PRINTED NAME EMPLOYEE SIGNATURE WWID DATE
NOTE: To begin the enrollment process or to find additional information on program costs, visit the My Health Benefits Web site; from Circuit, search for My Health Benefits or from the Internet at www.intel.com/go/myben. If you have questions about your health benefits, benefit costs or enrolling, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236). For complete information on Intel’s Health and Disability programs visit the Pay, Stock and Benefits Handbook. From Circuit, search for Pay, Stock and Benefits Handbook.
Intel Confidential NEONHBensigform12/4/2013 Intel offers a New Hire Pay & Benefit course to all new hires. This course will provide an overview of the medical, dental, flexible spending accounts, life insurance, disability, stock and retirement benefits offered by Intel. Following your Start Date, if you are interested in attending the course, please visit “Circuit > My Learning> My Learning Tool”. In My Learning Search, type New Hire Pay, select Virtual Classroom (VC) from the drop down menu, check mark Match Exact Phrase and click Search. Refine the search result by clicking Sites, selecting All sites and click Apply. The results will display the available offerings for the class. Click Register in the offering that best suits your calendar. A registration confirmation will show up.
How do I locate information regarding my employer’s
current workers’ compensation carrier?
For information regarding your employer’s workers’ compensation carrier, please visit the below website.
https://www.caworkcompcoverage.com
If the workers’ compensation policy has expired, contact a Labor Commissioner at the Division of Labor Standards
Enforcement - their number can be found in your local White Pages under California State Government, Department of Industrial Relations.
You can get free information from a State Division of Workers' Compensation Information & Assistance Officer.
The nearest Information & Assistance Officer is at:
Please refer to the attached I&A Office directory for the nearest location. Hear recorded information and a list of
local offices by calling toll-free (800) 736-7401. Learn more online: www.dir.ca.gov.
False claims and false denials: Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony and may be fined and imprisoned.
Your employer may not be liable for the payment of workers’ compensation benefits for any injury that arises from your voluntary participation in any off-duty recreational, social, or athletic activity that is not part of your work-related duties. MPN Identification Number: #2323
(physician or designated employee of the physician)
The physician is not required to sign this form, however, if the physician or designated employee of the
physician does not sign, other documentation of the physician’s agreement to be pre-designated will be
required pursuant to Title 8, California Code of Regulations, section 9780.1 (a)(3)
Page 6
Data Protection Authorization for New Hires
Congratulations on your recent internship or employment with Intel. As part of our new hire paperwork, we request
that you read the following authorization and check the appropriate box below.
Some of the information you are submitting to Intel may be considered personal information and governed by data
protection laws. Intel is committed to complying with applicable data protection laws. As a result, we hereby obtain
your authorization to collect, use, store and transfer your personal information to our global employee database
currently located in California, U.S.A. For some specific applications, such as email services, Intel utilizes cloud
computing technology. Intel will not sell or rent your personal information to third parties without your explicit
consent. We do use third party vendors to provide services on behalf of Intel (for a complete list of those vendors
and the services they provide, please contact Intel HR). These vendors have met our requirements for data
protection compliance. Your personal information will be controlled with access limited to those Intel employees or
vendors contracted by Intel who have a business need to access your personal information. Access rights may
include human resources personnel, your managers and their designees, IT, and limited number third party service
providers responsible for administering your benefits. Access to your personal information will include the
following purposes:
1) Management of the internship or employment relationship – demographic information such as home
address, telephone number, email address, or legally required information such as social security number,
national identification number or its equivalent, and country of citizenship, birth date and gender; 2) Training and career development – information pertaining to education, skills, certifications, training
requirements, training history, course completed/needed, performance evaluations/reviews; 3) Program participation - information needed for enrolment and/or administration of special programs
offered by Intel such as benefits, training programs, succession planning, and any other program you
specifically join; 4) Management of IT and Facilities Services to include office, telephone, email, and computer equipment,
services and access rights; 5) Payroll processing - using information such as your salary, bank account details, total deductions,
allowances, etc.; 6) Intel to know where you work, your work hours, and how you spend your work time - using information
such as work location, job title, supervisor, cost center time/absence records etc.; 7) Support for your technical resource needs, including support of your computer and communications
hardware and software, through Intel’s Technical Assistance Center. 8) Participation in core HR processes - using information such as performance rating, merit increase, job
grade, competencies, development plan, general pay awards, training programs, stock, etc.; 9) Participation in Corporate programs such as bonus or commission plans wherever appropriate, allowances
and awards, stock programs, etc.; 10) Inclusion of your work contact details in the worldwide telephone directory and email directory in order to
facilitate internal communications and foster global teamwork;
11) Enablement of you and your family to participate easily in the various benefit programs - using information
such as family members to be covered by insurance, beneficiaries, etc.; 12) Fulfillment of government reporting requirements - using information such as tax information and other
statutory information; 13) Fulfillment of corporate and statutory audits conducted by our third party auditors; 14) Generation of internal reports for headcounts, budgets, workforce planning, training, etc.; 15) Management of the relocation process – using demographic and legally required information, including
basic information on your family members relocating with you; 16) Participation in Intel’s Community website to keep informed of marketing opportunities, newsletters,
Rev 7, 2014
events, special programs, and the ability to communicate with other Intel community members; 17) Inclusion in specific bench marketing and survey activities related to employee productivity and efficiency
in order to increase Intel performance as a company; or 18) For the purpose of Open Door investigations should Intel have “probable cause” to search your email and
laptop due to suspected violations of company policies, including Intel guidelines such as the Electronic
Communications Guidelines, and/or criminal or illegal activities. Intel may also review and disclose your personal information in order to protect Intel and its employees and assets,
including to: (1) safeguard the legal rights, privacy, and safety of Intel or its employees, partners, or contractors; (2)
protect the safety and security of visitors to Intel’s web sites or other properties; (3) investigate and protect against
violations of Intel’s policies, fraud, or other illegal activity or for risk management purposes; (4) respond to inquiries
or requests from law enforcement and other public authorities/government agents; (5) permit Intel to pursue
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