Fillable Ethics Conflict Disclosure Form Layout 1

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Ethics Conflict Disclosure Form Layout 1

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U.S.A. forms for City of Phoenix

BROWSE CITY OF PHOENIX (AZ) FORMS

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CONFLICTS IN EMPLOYMENT, SUPERVISORY AND
CONTRACTUAL RELATIONSHIPS DISCLOSURE FORM
(Refer to A.R. 2.91)
Name: ______________________________________________________________________ Date: ________________________
Job Title: ___________________________________________________________________________________________________
Department/Division: _______________________________________________________________________________________
Name(s) of the relative(s) or individual(s) working for the City with whom I may have a conflict:
Name Department Job Title Relationship
Other Potential Conflicts:
Please use the space below to declare other employment, supervisory, and/or contractual conflicts as noted in A.R. 2.91.
Signature: ______________________________________________________ Print Name: ______________________________
Supervisor’s Signature: ___________________________________________ Print Name: ______________________________
Department Head’s Signature: ____________________________________ Print Name: ______________________________
Original: Department Personnel File
Copy: Employee
60-601D New 11/08
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Ethics Conflict Disclosure Form Layout 1

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Completed 12 July 2020

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