Arizona State Personnel System
Division, Section, Unit
New Hire - Initial Disclosure
Current Employee - New Disclosure
The Arizona Revised Statutes (A.R.S.) and State Personnel Rules place some restrictions with which you must comply regarding
business interests, secondary employment, and employment of relatives*. To determine that you are in compliance with these
provisions, you are required to complete the following information when you are first employed by the State and any time there is a
change. This document will become part of your official personnel file.
Business Interests
Are you involved in any ownership, employment, public or private affiliations, or special arrangements which may have a substantial
interest in any contract, sale, purchase, service or decision involving the State of Arizona?
No, I am not.
Yes, I am.
If yes, please describe your involvement:
Are any of your relatives involved in such activity? (Relative means: spouse, child, grandchild, parent, grandparent, brother or sister
of the whole or half blood and their spouses, and the parent, brother, sister, or child of a spouse, pursuant to A.R.S. §38-502).
If yes, please list their names, relationship to you, and their involvement:
Secondary Employment
I am not engaged in any outside employment
I have another job at:
Employer Name Address
ork Schedule
Average Hours Per Week
Please describe duties:
ASPS/HRD-FA5.03 06/20
Relative(s) at State of Arizona
Do any of your relatives currently work for the State of Arizona? (Relative means: spouse, child, parent, grandchild, grandparent,
sister, brother, great grandchild, great grandparent, aunt, uncle, niece, nephew, or first cousin who is related to you by marriage [in-law
or step] or blood, pursuant to State Personnel Rule R2-5A-305).
If yes, p
lease list their names, relationship to you, and the agency in which they work:
I understand that if there are any changes to the above information, I am responsible for completing a new disclosure
form immediately and submitting it to my supervisor.
Employee Signature
*Specific information on Conflict of Interest/Standards of Conduct for State Employees is available in A.R.S. §38-501 through §38-510
inclusive, State Personnel Rules, and the State Personnel System Employee Handbook.
Distribution: Original to Employee's Personnel File; copy to agency's Human Resources Office
ASPS/HRD-FA5.03 06/20
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