Arizona State Personnel System
DISCLOSURE STATEMENT
Name
Agency
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).
No
Yes
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
W
ork Schedule
Average Hours Per Week
Please describe duties:
ASPS/HRD-FA5.03 06/20
