Applicant Disclosure Form

Download a blank fillable Applicant Disclosure Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Applicant Disclosure Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Print Form
DISCLOSURE OF NAMES OF FAMILY MEMBERS WHO
ARE STATE EMPLOYEES
Disclosure Required by G.L. c. 268A, Sec. 6B
Name of Applicant for Employment: _____________________
Date: ____________
Is your spouse, parent, brother, sister or child, or the spouse of your parent, brother, sister
or child, a state employee?
Yes
No
If you answered Yes, please list below the name(s) of any state employee who is your
spouse, parent, brother, sister or child, or who is the spouse of your parent, brother, sister
or child, and indicate their relationship to you. Please also list the name of the state
agency that employs those relatives.
NOTE: For purposes of this disclosure, a “state employee” is a person holding a paid or
unpaid office, position, employment or membership in a Massachusetts state agency. For
purposes of this disclosure, a “state agency” is any department of Massachusetts state
government, including any department or agency within the executive, legislative or
judicial branch, and all councils thereof and thereunder, and any division, board, bureau,
commission, institution, tribunal or other instrumentality within such department or
agency, and any independent state authority, commission, instrumentality or agency, but
NOT INCLUDING an agency of a county, city or town.
Name of Relative
Relationship to Applicant
Name of State Agency
____________________
_____________________
____________________
____________________
_____________________
____________________
____________________
_____________________
____________________
____________________
_____________________
____________________
____________________
_____________________
____________________
____________________
_____________________
____________________
____________________
_____________________
____________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go