Conflict of Interest Statement

CONFLICT of INTEREST STATEMENT
It is the responsibility of each employee to recognize and avoid any situation involving a business conflict of interest. Employees are expected to promptly disclose any known relationships or activities that may result in real or apparent conflicts of interest. This information is disclosed to your Supervisor and/or the Agency Manager, thereby allowing issues to be worked before they develop into a problem. Through this action, an employee protects their own interests as well as those of Care4Everyone.

All employees must complete this Conflict of Interest Statement upon hire and update the Statement annually or whenever the status changes.

Activities/situations that create a conflict of interest, or the appearance of one, must be declared on this Conflict of Interest Statement.
Name

First NameLast Name
1. Do you have an outside job that may create a conflict of interest with your employment at Care4Everyone?

YesNo
Describe
2. Do you have any other conflict of interest with your employment with Care4Everyone?

YesNo
Describe
I understand that failure to observe and abide by these obligations may result in disciplinary action which may include dismissal and/or contract termination.

I also understand that in some cases, failure to observe and abide by these obligations may result in criminal or other legal actions.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

CONFLICT of INTEREST STATEMENT