Outside Employment Conflict Disclosure
Employee Name
Position/Title
Department
Date
Outside Employment Information
Outside Employer Name
Employer Address
Outside Position/Role
Brief Description of Responsibilities
Estimated Weekly Hours Committed
Do any duties of your outside employment overlap with your nonprofit responsibilities? If so, please describe.
Are there any potential conflicts of interest you are aware of?
Acknowledgment
I acknowledge that I have read and understand the nonprofit organization’s conflict of interest policy. I agree to disclose any potential conflicts in the future.