This is a template form used when a Right to Represent is required.

I, ${{memberfullname}}, grant the right to represent my profile for select career opportunities. I further allow for Disruptive Outcomes to contact me from time to time regarding potential opportunities and the market in general.

Target Companies

As discussed with Disruptive Outcomes, I grant the right to represent me to these companies:



I grant Disruptive Outcomes the right to represent me to other companies or confidential requirements upon my confirmation either in writing, text message, or via email.

I confirm that I have not given consent to any other recruiter or submitted my profile on my own to any of these companies within the last 12 (twelve) months.

I agree to give advance warning if I plan to work with another recruiter or represent myself to a company which I have previously or hereby given Right to Represent.

Avoid Companies

I am in process with, represented to, or prefer not to be contacted regarding opportunities with these companies:


By signing this Right to Represent, I understand that I will be disqualified from any process where I have made a false disclosure.

I additionally reserve the right to retract this Right to Represent with prior notice. Any retraction will not affect introductions made while this agreement is in place. Any introduction will automatically lapse 12 (twelve) months from the date of introduction.

By esigning below, I confirm and agree to this Right to Represent.