Conflict Of Interest Policy And Disclosure Form For Challenge Employees printable pdf download

Conflict of Interest Policy and Disclosure Form

for Challenge Employees

A conflict of interest exists when there is evidence of or the appearance that an employee’s personal

interests have influenced or may influence Agency transactions or operations, or that these interests

take precedence over the interests, goals, and/or mission of the Agency. A conflict of interest may

relate to you, your spouse/partner, family member, business interests, and/or associates in areas

such as:

I (or a party related to me) hold, directly or indirectly a position of financial interest in an

outside concern from which Challenge secure goods or services.

I (or a party related to me) render directive, managerial, or consultative service to, or am an

employee of, any outside concern that does business with Challenge.

I have accepted gifts or other benefits from any outside concern that does, or is seeking to

do, business with Challenge.

At Challenge, I have participated in management decisions concerning transactions that

affect or benefit me, my family, or my personal financial interests.

A party related to me has received or continues to receive services from Challenge.

Challenge is responsible for knowing what conflicts might exist and to manage, reduce, or eliminate

those conflicts. The key to handling these potential conflicts is full disclosure of any potential conflict

or the appearance of a conflict. It should be noted that we believe it appropriate to disclose any

family members that may be supported by, employed by, a vendor of, or business associate of

Challenge. Each employee will complete an annual conflict of interest disclosure form to inform

Challenge of situations that pose or may give the appearance of conflict of interest.

If you have questions as to whether a conflict of interest exists, we encourage you to discuss this

with Human Resources or Challenge’s Compliance Officer and/or disclose this information on the

form.

I certify by signing below I acknowledge receipt of the Employee Conflict of Interest Policy and that

I have accurately completed this disclosure form to the best of my knowledge.

Please check the statement that pertain to your disclosure:

I hereby report that to the best of my knowledge, information and belief, no situation in which I

am involved personally or professionally could be construed as a violation of the Employee

Conflict of Interest Policy, or as placing me in a position of having a conflict of interest with

Challenge*.

I hereby disclose the following circumstances that may constitute a conflict of interest, as

described in the Employee Conflict of Interest Policy above (please document all situations

below that are or may be considered a conflict of interest)*:

___________________________________________________________________________

Conflict Of Interest Policy And Disclosure Form For Challenge Employees