Fillable 131 01 OGC Lgl Svs Outside Employment Form (USPS Office of Inspector General)

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131 01 OGC Lgl Svs Outside Employment Form (USPS Office of Inspector General)

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OFFICE OF INSPECTOR GENERAL
UNITED STATES POSTAL SERVICE
Non-Agent / Non- Investigator Outside Employment Notification
Date Initial Request Updated/Renewal Request
Part 1: Employee Information
Name
(last, first, mi)
OIG Functional Area Phone
Do you file a financial
disclosure report?
Public
(Form 278) Confidential (form 450) No
Part 2: Outside Employment or Business Activity Information
Outside Employer Name and Description of Business / Activity
(If you are teaching, provide the name of the class and a description of the subject matter)
Self employed
Teaching
Point of Contact
Title
Employer address
Phone
email
Volunteer position Yes No Frequency of Activity
Part 3: OIG Duties Conflict
Could the way you perform (or don’t perform) your official OIG duties predictably affect the financial interests of
the employer or entity for which the proposed outside activity will be performed:
No, none of my official duties relate in any way to the proposed outside activity
Yes, my official duties relate to the proposed activity in the following manner:
(Explain)
11/18 Page 1 of 2 OIG 131-01
The OIG is authorized by law to collect the information on this form.
For an explanation of how the OIG may disclose this information, see the Privacy Act Statement at IGM 741.
Full Time (40 hrs per week)
OFFICE OF INSPECTOR GENERAL
UNITED STATES POSTAL SERVICE
Non-Agent / Non- Investigator Outside Employment Notification
Part 4(A): Employee Certification
I understand that my outside employment or activity is governed by the Standards of Ethical Conduct (see C.F.R. Part 2635, 5 C.F.R.
Part 7001, and 39 C.F.R. Part 447) and hereby certify that:
I do not interact with the employer or activity in my official capacity;
I will avoid actual or apparent conflicts of interest in the performance of outside employment or activity;
The outside activity or employment or activity will not interfere with my official duties or official travel;
I will not use official time (including personal leave), property of information to perform the outside employment or activity;
The outside employment or activity will not in any way interfere with my ability to perform my OIG duties to the best of my
ability; and
I will promptly notify my supervisor should any potential for violations of the regulations appear and will take appropriate
steps to rectify the situation.
Signature
Title
Date
Part 4(B): Supervisor Certification
I have reviewed this form with the employee and do not believe the outside employment or
activity will affect their ability to perform their official duties or responsibilities
Name
Signature
Date
Title
Part 5(C): Office of General Counsel Certification
OGC Reviewer
Signature
Date
11/18 Page 2 of 2 OIG 131-01
The OIG is authorized by law to collect the information on this form.
For an explanation of how the OIG may disclose this information, see the Privacy Act Statement at IGM 741.
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131 01 OGC Lgl Svs Outside Employment Form (USPS Office of Inspector General)

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Completed 25 July 2020

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