Outside Business Activities Disclosure Form
Please disclose any outside business activities to ensure transparency and compliance with company policy.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Department
*
Please Select
Finance
Operations
Sales
Marketing
Human Resources
IT
Other
Your Position/Title
*
Name of Outside Business/Employer
*
Describe the outside business activity
*
Your role in the outside business activity
*
Start Date of Outside Business Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Estimated weekly time commitment (hours)
*
Is the outside activity related to or in competition with your current employer?
*
Yes, related
Yes, in competition
No
Do you foresee any potential conflicts of interest resulting from this outside business activity?
*
Yes
No
Not sure
Supervisor/Manager Name
*
Supervisor/Manager Email
example@example.com
Please attach any supporting documents (optional)
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of
Signature
*
Submit Disclosure
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