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  • Employer Liability Acceptance Form (2021)

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    jb_uspu
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    Due to continuing "deprivation of Rights" masked as COVID "mandates" executed by both government agencies and private employers, without any "informed consent" by and "against the will" of many Americans, under threat of loss of income and opportunity, this form is made available for public use.

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    Due to continuing "deprivation of Rights" masked as COVID "mandates" executed by both government agencies and private employers, without any "informed consent" by and "against the will" of many Americans, under threat of loss of income and opportunity, this form is made available for public use.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    856 views1 page

    Employer Liability Acceptance Form (2021)

    Uploaded by

    jb_uspu
    Due to continuing "deprivation of Rights" masked as COVID "mandates" executed by both government agencies and private employers, without any "informed consent" by and "against the will" of many Americans, under threat of loss of income and opportunity, this form is made available for public use.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Employee Health Policies

    Employer Liability Acceptance Form

    I, COMPANY OFFICIALS NAME: ____________________________ , as an official representative of COMPANY NAME:


    _____________________________________ in the official company capacity of JOB TITLE:
    _________________________________________ charged with the duty of executing said company’s employee health
    policies as a stated “condition of employment,” which may include company policies potentially harmful to employee
    including the use of, coercion, bribery or any threat of loss of employment and income, or any other means of coercion,
    hereby state that I fully understand the actions I am taking, and that I ACCEPT FULL LEGAL, FINANCIAL AND HEALTH
    CONDITION LIABILITY, both professionally and personally, for any and all damages affecting employee, which may arise
    as a result of my actions to enforce and execute said “Company” employee health policy, and hereby acknowledge that I
    am executing and enforcing said policies without providing employee proper information in order for the employee to
    offer any “informed consent.” “EMPLOYEE” shall include all under direct employment and all private “contractors” that
    fall under said company health policies being enforced.

    Liability for “forced or coerced” health policies will include, but are not limited to; forced masking, forced quarantine,
    forced house arrest, forced medical treatments of any kind, any forced vaccinations, inoculations, injections, whether
    approved by government agencies or not, related employee abuse or “shaming,” discrimination, or otherwise
    infringement upon employee Constitutionally protected Natural Rights, individual liberties, or Civil Liberties.

    COMPANY NAME: _____________________________________________________________________

    COMPANY HQ ADDRESS: _______________________________________________________________

    COMPANY PRIMARY PHONE: ____________________________________________________________

    PRESIDENT/ CEO NAME: ________________________________________________________________

    COMPANY OFFICER: ___________________________________________________________________

    OFFICER HOME ADDRESS: ______________________________________________________________

    OFFICER HOME PHONE: ___________________________ MOBILE PHONE _______________________

    DATE POLICY IS BEING FORCED UPON EMPLOYEE: __________________________________________

    I, the undersigned, responsible for executing and enforcing company health policies upon employee, without their
    “informed consent” and “against their will” fully understand the actions I am taking and that I am completely liable, on
    behalf of company and myself, for any adverse effects, losses to the health, financial or other well-being of employee,
    due to my actions today.

    SIGNED: ____________________________________ DATE: ______________________


    Both Professionally and Personally

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