JPMC PRE-ASSIGNMENT STATEMENT
Supplier Name: ____________________________________________________________
Designated Supplier Personnel Name: ___________________________________________
Designated Supplier Personnel Signature: ________________________________________
Date:
1.
I understand that I am an employee of the Supplier listed above and that I am not eligible for, or entitled
to, any employment status with, or employment benefits of or from, JPMorgan Chase & Co., JPMorgan Chase
Bank, National Association, or any of their direct or indirect subsidiaries, affiliates, parent companies, successors
or assigns (“JPMC”).
2.
I understand that conversations on JPMC’s telephone lines may be monitored by or on behalf of JPMC,
and, from time to time, such telephone conversations (whether business-related or personal) may be recorded by
or on behalf of JPMC. JPMC reserves the right to use the recordings and information obtained from them in any
manner permitted by law. In addition, voicemail and computer usage (including, but not limited to, e-mail and
internet usage) may also be monitored by or on behalf of JPMC.
3.
Have you ever been assigned to or employed by JPMorgan Chase & Co., JPMC or any of their direct or
indirect subsidiaries, affiliates or predecessors, including The Chase Manhattan Corporation, The Chase
Manhattan Bank, Chemical Bank, The Chase Manhattan Bank, N.A., Bank One Corporation, Bank One, N.A.,
Bank One, Delaware, N.A., Bank One Trust Company, N.A., J.P. Morgan & Co. Incorporated or any of its direct
or indirect subsidiaries, affiliates or predecessors, including Morgan Guaranty Trust Company of New York; The
Bear Stearns Companies, Inc., Bear, Stearns & Co. Inc., Bear, Stearns Security Corp., Washington Mutual fsb,
Washington Mutual Bank, or Washington Mutual, Inc. (collectively “JPMorgan Chase”)?
No
Yes
If “Yes”, please specify assignment or position, along with dates of assignment or employment:
______________________________________________________________________________
Were you involuntarily released from the assignment or position?
No
Yes
If “Yes”, please explain: _________________________________________________________
4.
Are any of your relatives (that is anyone related to you by blood, marriage or law) or members of your
household currently employed by or assigned to work at JPMorgan Chase?
No
Yes
If “Yes”, please specify name of relative or member of household, position and department:
_______________________________________________________________________________
5.
Have you ever been convicted of, plead guilty or no contest to, or entered into a pre-trial diversion or
similar program concerning any criminal offense (e.g., a misdemeanor or a felony) involving a crime of
dishonesty, breach of trust, money laundering, or felony involving violence or drug offenses including the illegal
manufacture, sale distribution or trafficking in controlled substances?
Do include any guilty pleas or convictions pursuant to a plea bargain or pre-trial diversion program.
Do not include the following: (1) minor traffic violations, (2) convictions or pleas as a youthful offender or
juvenile, or (3) any criminal proceedings which have been terminated in your favor (e.g., any acquittals or
convictions which have been deleted, voided, invalidated, expunged or sealed by a court).
NOTE: Responses concerning plea bargains or pre-trial diversions should not be provided in states which restrict
such inquiries. These states include, but may not be limited to California.
No
Yes
If “Yes”, please explain: _________________________________________________________
6.
Have you been charged with or arrested for any criminal offense described above for which you are
awaiting disposition, dismissal, termination, further court proceedings or a final resolution? Include any pending
criminal case which has been postponed pursuant to a pre-trial diversion or similar program.
NOTE: Responses concerning unresolved charges or arrests should not be provided in states which restrict such
inquiries. These states include, but may not be limited to Arizona, California, Illinois, Indiana, Iowa, Kansas,
Massachusetts, Michigan, Minnesota, Nevada, New Mexico, Ohio, Rhode Island, Utah, Washington, and West
Virginia.
No
Yes
If “Yes”, please explain: __________________________________________________________
7.
If you answered ”Yes” to either question five or six, please note that, consistent with applicable law, a
conviction or unresolved criminal charge or arrest will not result in an automatic disqualification from your ability
to provide services at JPMC. As appropriate, factors such as the date, nature, job relatedness and seriousness of
the offense will be considered. However, please be advised that the Federal Deposit Insurance Act provides that
“. . . any person who has been convicted of any criminal offense involving dishonesty or a breach of trust, or
money laundering, or has agreed to enter into a pretrial diversion or similar program in connection with a
prosecution of such offense, may not participate, directly or indirectly, in the conduct of the affairs of any insured
depository institution . . .”. Crimes involving violence or drug offenses may come under this definition and JPMC
also has certain bonding requirements.