Fillable Conflict of Interest Disclosure Details Form Question F (Vanderbilt University)

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Conflict of Interest Disclosure Details Form Question F (Vanderbilt University)

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Conflict of Interest Disclosure Details Form – Question F
Name: ________________________________________ Job Title: _________________________
(PLEASE PRINT CLEARLY)
Department: ____________________________________________________________________
Part F. Overlapping Time Commitments
1. Do you have another job at Vanderbilt (other than your regular position)?
( ) Yes ( ) No
If YES, list your additional position at Vanderbilt and the name of your supervisor for the additional
position.
Position: ______________________________________________
Hours per week: ________________________________________
Supervisor: ____________________________________________
Phone: _______________________________________________
2. Do you have other activities that create overlapping time commitments with your Vanderbilt employment?
( ) Yes ( ) No
If YES, please explain:
3. Has your supervisor or department head approved this activity or additional employment?
( ) Yes ( ) No
Approved by: ________________________________________
Date: ______________________________________________
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Conflict of Interest Disclosure Details Form Question F (Vanderbilt University)

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Completed 24 July 2020

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