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How to write your own Financial Conflict of Interest Report

You can create your own customized editable version of this contract document using Human Resources Contract Pack. Follow these steps to get started.


Use the Financial Conflict of Interest Report form for all interests required to be disclosed that impact the employment or obligations as an official of an employee with the company.
Document Length: 3 Pages
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1. Get Human Resources Contract Pack that includes this business contract document.

This Financial Conflict of Interest Report is included in editable Word format that can be customized in Word or by using the included Wizard software.

2. Download and install after ordering.

Once you have ordered and downloaded your Human Resources Contract Pack you will have all the content you need to get started with your own formal declaration.

3. Customize the contract template with your own information.

You can customize the contract document as much as you need. You can also use the included Wizard software to automate merging in name/address data.

Financial Conflict of Interest Report

Writing the Financial Conflict of Interest Report document

Conflict of Interest and Disclosure Report

Use this form for all interests required to be disclosed that impact your employment and/or obligations as an official with Company Name and comply with Insert your State or Company Policy Reference here, or let this stand "as is". This report must be filed annually for all Directors and Officers. Additional sheets may be attached as necessary.

A Supervisor must complete the following form and file it with the Human Resources Department. IMPORTANT: When answering each question in this form, you must include sources of income and disclosures as they apply to your spouse and dependent children.

Sources of Income

Please list all your sources of income of more than $600 per year. Sources of income to list include salaries, hourly employment, directorships, dividend and investment income, interest payments, annuities or other settlements.

Investments and Ownership

Please list any investments in or ownership of public or private corporations, stock or other business organizations that are in excess of $5,000 or constitute a 5% or greater ownership stake. You are not required to list specific amounts of your investments. Instead you should specify, as an example, that you have an investment in "xyz" firm who is in the "abc" industry.

Lobbying and Retainer Fees

Please list any persons, firms, or organizations for whom lobbying, compensated or not, is performed by you or your family members. Please include non-dependent children in your answer for this question.

Professional Services

Please list all professional services you or your spouse provide, such as attorney, accountant, or consultant, and the interests that you provide them for as a general overview (e.g., industry, company type, etc. Please list any bankruptcy, default, or discharge of debt received in any United States District Court within the last ten years of the date on this form.

Loans and Debt

Please list all loans or combination of loans that total more than $1,000 from the same source. Private loans made to family or children are not required to be disclosed, provided that you are not a co-signer on an instrument of debt for a loan made to family or children.

Additional Information

Please list all other financial disclosures or disclosures of employment, offices or positions held, public service or legislative employment, or any other disclosure you want to make. Employee / Officer Signature Date.

Supervisor Signature Date

For Office Use Only

Received By signator, authorized signature or signer

Human Resources Manager Date

Human Resources Name

Human Resources Phone

Human Resources Email

The complete Financial Conflict of Interest Report - with the actual formatting and layout - is available in this Contract Pack.
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Related documents may be used in conjunction with this document depending on your situation. Many related documents are intended for use as part of a contract management system.

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Create winning business proposals & contracts with minimal effort and cost. Proposal software, proposal templates, legal contracts and sample proposals.