We check in with you yearly to ensure we have your current contact information, credentials, licenses, etc. We also want to ensure that you remember the terms of your engagement with Rodgers Security Solutions and our clients. Please complete the forms below to ensure we have current and accurate information for you. Thank you!

  • Annual Compliance Check-In Form
  • Conflict of Interest Disclosure Form
  • NDA Acknowledgment Form
Annual Compliance Check-In
Each year, all RSS employees and contractors are required to complete this form to ensure that RSS maintains accurate and up-to-date information about everyone performing work for or with the company. As a compliance-driven organization, RSS is committed to adhering to legal and contractual obligations. Consequently, all individuals or entities representing or working for RSS in any capacity must also meet the standards set by our clients, as well as local, state, and federal regulations. With this in mind, please make sure you provide current and accurate information.
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Name
Which Services Do You Provide Through RSS?
If you provide security and/or executive protection services.
Confirm Which Taxpayer ID Number RSS Should Have on File For You

CONTACT INFORMATION

I Have Changed The Following Within The Last 6-10 Months
Does RSS Have Current Information For Your Two (2) Emergency Contacts?
We want to ensure that we can notify your emergency contacts if you are ever injured or involved in an incident at a client site/event.

TAX INFORMATION

RSS Has My Current W4/W9 Tax Form on File
Please note, if we don’t have current information for you this will delay the processing of your tax forms.

LICENSES & PERMITS

I Confirm I Am Current With The Following Licenses and Permits:
Check all that are applicable

CERTIFICATIONS

I Confirm I Am Current With The Following:
Click or drag files to this area to upload. You can upload up to 15 files.
Upload copies of any of the documents, IDs, permits, etc that you need to update

ATTESTATION

I confirm that the information I have provided is truthful, current, and accurate.
Conflict of Interest Disclosure Form
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Instructions:

All employees, contractors, and affiliates of RSS are required to complete this form annually and whenever a potential conflict of interest arises. Please provide complete and accurate information to the best of your knowledge. If you have any questions or need assistance in completing this form, please email the HR Department or contact them by phone.

Personal Information

 

Name

Disclosure Questions

 

Outside Employment/Business Interests: Do you have any outside employment, business interests, or affiliations that could potentially conflict with your duties at RSS?
Financial Interests: Do you or any immediate family members have a financial interest (e.g., ownership, investment, partnership) in any entity that does business with RSS?
Personal Relationships: Do you have any personal relationships (e.g., family, friends) with individuals who are employed by or have a business relationship with RSS?
Gifts and Hospitality: Have you received any gifts, hospitality, or other benefits from individuals or organizations that do business with RSS?
Other Potential Conflicts: Are you aware of any other situations or activities that could create a conflict of interest or the appearance of a conflict of interest?

Certification

 

I certify that the information provided in this disclosure form is true and complete to the best of my knowledge. I understand that any misrepresentation or omission may be grounds for disciplinary action, up to and including termination of employment or contract.
A copy of this disclosure will also be emailed to you.

NDA Acknowledgment Form

After reading the Non-Disclosure Agreement and any Addenda, this form acknowledges receipt and acceptance of the terms as outlined.
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Name
I acknowledge that I have received, read, and agreed to the terms as outlined in the Non-Disclosure Agreement. I understand that violation of the agreement could result in legal consequences, as outlined in the agreement. By checking this box and submitting this form, I am bound by the terms outlined in the agreement.
I acknowledge that I have received, read, and agreed to the terms as outlined in the Addendum to the Non-Disclosure Agreement. I understand that violation of the NDA and Addendum could result in legal consequences, as outlined in both documents. By checking this box and submitting this form, I am bound by the terms as outlined.
This acknowledgment is ONLY for individuals who received a client-specific Addendum that is combined with the NDA. If you were not given an Addendum in addition to the NDA, then please click “Not Applicable.” Thank you.
Please type the name of the client or client account details to signify that you are submitting this acknowledgment in regards to that specific client. If you did not receive an Addendum in addition to an NDA, please skip this statement or type Not Applicable or N/A.
Click or drag files to this area to upload. You can upload up to 4 files.
If you chose to complete a paper version instead of the digital version.
00-00-202X
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