Information about the Conflict of Interest in Employment, Faculty/Academic Staff form

Only one form needs to be completed and submitted per set of relatives.

Employee A/B: Last, first, middle name as recorded on the Social Security card.

Department/College: The primary department/college has administrative responsibility for employee. If there is more than one department, list each department/college with the primary unit first. Enter the full department name or the 18 character common code abbreviation. For the department code, use the three-digit department common unit code; for the college code use the two-digit college common unit code.

Recommended by: Signatures must be the chairperson/director's and dean/MAU administrator's name with designee's initials below, as applicable. In the case of a multiple appointment the signatures for each unit involved are required. Each signer must date her/his signature.

Routing: This form is usually submitted as an electronic attachment to an Appointment, Reappointment or Change of Status form and is routed electronically accordingly. If the form is processed by itself (for example, when a relationship first comes into existence while the two employees are employed in the same unit or under the same supervisor) the routing is: All departments and colleges involved; Associate Provost and Associate Vice President for Faculty and Academic Staff Affairs; Faculty and Academic Staff Affairs.