Conflict of Interest Declaration

This form requires Employees of Squared Away Incorporated to disclose details of any and all interests that are relevant that may be in conflict with their duties and responsibilities in providing disability supports.

A conflict of interest occurs when an individual's personal interests – family, friendships, financial, or social factors – could compromise his or her judgment, decisions, or actions in the workplace. This can also include:

Professional (previously worked history with someone)
Outside Employment (if you are employed elsewhere)
Financial (direct and indirect financial gain and interests)
Other (any other relationship that does not fall into these categories)

The Conflict of Interest Declaration will be documented in the Squared Away Conflict of Interest Risk Register to manage ongoing conflicts or potential conflicts.

Please fill out this form as a declaration of a potential conflict of interest to Squared Away Incorporated.

Your Details: Full Name

First NameLast Name

Conflict of Interest: Full Name

First NameLast Name

Your relationship to the Conflict of Interest

Personal (Family/friendship/romantic/neighbour/friend of a friend)Professional (Previous worked history e.g., former colleague)Outside Employment (Currently working elsewhere)Financial (Direct and Indirect Financial interests)Other

Please provide more details about you and the Conflict of Interest

Describe the history you have with the conflict of interest and why this person is a conflict of interest.

By submitting this form, I declare to the best of my knowledge that:

The information provided in this declaration is true and accurate.I make this conflict of interest declaration with the above details being true and correct to the best of my knowledge and in good faith.I acknowledge that Management can contact me further regarding this Conflict of Interest Declaration

Date signed

Date