GADSDEN STATE COMMUNITY COLLEGE
FAMILY RELATIONSHIP DISCLOSURE FORM
Employee’s Name:
Job Title/Position:
Employment Date: ___ Full-Time Part-Time
Salary Schedule: Rank: Step: Annual Salary:
For purposes of this disclosure, relative includes any person related within the fourth degree
of affinity or consanguinity to any job, position, or office of profit with the 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
Revised January 2017
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