CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS
EMPLOYMENT OF IMMEDIATE FAMILY MEMBERS FORM
Nepotism Compliance Agreement
This form is to be completed when an employee is assigned to a position under the supervision or control of an immediate
family member or when immediate family members report to the same supervisor (includes faculty member or members
reporting to department chair). This form also acknowledges that the employee who has signed below has read the
campus policy on nepotism.
Fill in all that apply:
All personnel decisions including salary, appointment, evaluation, retention, tenure, compensation adjustments,
termination, or other employment status or interest for _________________________ (employee name) will be
determined by _________________________ (head of unit, e.g., AVP, divisional supervisor, vice presidents, etc.).
_________________________ (name of related family member) shall not initiate or participate in any institutional
decisions involving a direct benefit (initial appointment, retention, promotion, salary, leave of absence, etc.) for
_________________________ (employee name) and shall not participate in discussions or votes designed to rank other
employees in relationship to _________________________ (employee name) for the purpose of such decisions.
_________________________, as manager of the organizational unit, shall be responsible for investigating concerns
about conflicts of interest or favoritism involving members of the same immediate family.
Special considerations to alleviate any pressures toward favoritism to be taken (if necessary):
Signatures:
______________________________________________ _______________________
Employee Date
______________________________________________ _______________________
Supervisor/Department Chair Date
______________________________________________ _______________________
AVP, Manager Date
______________________________________________ _______________________
Vice President Date
File copies in Faculty Affairs Personnel Action File and Human Resources.
