Conflict of Interest Disclosure Form
for Government Employees
Employee Information
Full Name
Position/Title
Department/Agency
Contact Information
Disclosure
Do you have any financial, personal, or other interests that could be seen as a conflict of interest in your government duties?
Yes
No
If yes, please describe the nature of the interest:
Have you, or an immediate family member, been involved in any outside employment, consultancy, board membership, or similar activities in the past 12 months?
Yes
No
If yes, please provide details:
Other Relevant Information:
I declare that the information provided in this disclosure is true and complete to the best of my knowledge.
Signature
Date