Conflict of Interest Disclosure Form


Without AUK’s written consent, the Employee should not, during the term of his/her employment, be interested directly or indirectly in being a partner, officer, director, advisor, employee, or serving in any capacity in another organization or institution.

A “conflict of interest” refers to any current professional, financial, or other interest that could: i) impair the Employee’s objectivity in carrying out his/her duties and responsibilities for AUK, or ii) create an unfair advantage for any person or organization. Circumstances that could lead a reasonable person to question an individual’s objectivity, or whether an unfair advantage has been created, constitute a potential conflict of interest. These potential conflicts are subject to disclosure. Also, Employee should disclose any personal, family business, or volunteer affiliations that may give rise to a real or apparent conflict of interest.

Employee’s Name:
Position:


1. Please describe below any relationships or positions you hold or circumstances that you believe could contribute to a conflict of interest. (Please note that you must specify non-profit and for-profit boards you and your spouse sit on, any for-profit businesses for which you or an immediate family member are director or manager, and the name of your employer and any businesses you or your family members own).



2. If as of the date of accepting employment at AUK, you severed all your ties to prior or existing relationships that would have constituted a conflict of interest, then you MUST provide documentation that the conflict of interest no longer exists.

3. I have no conflict of interest to report.

4. I hereby certify that the information set forth above is true and complete to the best of my knowledge.