FAMILY RELATIONSHIP DISCLOSURE FORM
Employee’s Name:
Job Title/Position:
Employment Date: ______________________________ Full-Time □ Part-Time □
Salary Schedule: Rank: Step: Annual Salary:
For the purposes of disclosure, relative includes any person related within the fourth degree of
affinity or consanguinity to any job, position, or office of profit with state or with any of its
agencies.
Are you a relative of any employee of the Alabama Community College System or any member of
the Alabama Community College System Board of Trustees?
Yes □ No □
If yes, list the name(s), relationship, and employer or the position of the relative(s)
My signature below affirms that all information contained herein is correct to the best of my
knowledge.
_____________________________ ____________________________
Employee’s Name Printed Employee’s Signature
_________________________________
Date
*Please see reverse side for an illustration defining relatives to the fourth degree.
Revised September, 2017
