DISCLOSURE OF OUTSIDE EMPLOYMENT

Auditor’s Office employees may engage in outside employment in accordance with Auditor’s Office Administrative Rule (“ARA”) 3.11 - Ethical Conduct, Chapter VII: Outside Employment and Volunteer Activities.

All Auditor’s Office employees¹ who engage in outside work, including volunteer activities that must be disclosed pursuant to ARA 3.11, must submit this form within 10 business days of engaging in the outside work.

All Auditor’s Office employees must submit this form annually, by January 1.

If you are uncertain about any potential or actual conflict, please disclose the possible conflict.

Please contact your Division Manager if you have any questions about this form.

1.  Employee Information

 Name:      ________________________________________________

 Division:      ________________________________________________

 Date Submitted:    ________________________________________________

2.  Disclosure of Outside Employment

Do you have outside employment (including self-employment)?

☐ Yes  ☐ No

3.  Disclosure of Certain Volunteer Activities

Do you perform volunteer activities for another City office or bureau, that are related to a City Council campaign, or that could create a potential or actual conflict of interest?

☐ Yes  ☐ No

4.  Disclosure of Other Potential or Actual Conflicts of Interest

Do you have any associations with local service providers, contractors for the City, or recipients of City funds, outside of your City job?

☐ Yes  ☐ No

If you responded “yes” to question #2, #3, or #4: Your Division manager may request additional information and/or a conflict of interest resolution / prevention plan to ensure that your outside employment complies with Auditor’s Office rules and City and State ethics rules.

_________________________________________    _______________________

Employee Signature            Date