A disclosure form employees complete to report outside activities, financial interests, and family relationships that could conflict with their duties. Use it at onboarding and for periodic refreshes.
This form asks you to disclose outside activities, financial interests, and personal relationships that could conflict — or could reasonably appear to conflict — with your duties to Company name (the "Company"). Completing it fully and honestly protects both you and the Company: most disclosed situations can be managed sensibly once they are known, while undisclosed ones damage trust when they surface later.
A conflict of interest exists when your personal, financial, or family interests could influence, or could reasonably appear to influence, the judgment you exercise on the Company's behalf. The appearance of a conflict matters as much as an actual one, because it shapes how colleagues, clients, and partners read your decisions. Typical situations include:
If you are unsure whether something belongs on this form, disclose it. It is far easier to conclude that a situation is not a problem than to explain later why it was never mentioned.
Answer every item below. Where nothing applies, write "none" — do not leave an item blank, because a blank entry cannot be distinguished from an omission.
The Company will review this disclosure and, where a conflict or potential conflict exists, agree measures with you to manage it. Measures may include recusal from specific decisions, an adjustment to reporting lines, additional oversight of particular transactions, or limits on an outside activity. A disclosed item is not, by itself, a finding of wrongdoing; most disclosures are resolved with simple safeguards. Failing to disclose a known conflict, by contrast, is treated as a serious matter under the Company's conduct standards.
Disclosures are handled confidentially and shared only with the people who need them to assess and manage the situation, such as your manager, human resources, and, where relevant, legal or compliance staff. The Company does not use this form for any purpose unrelated to managing conflicts of interest.
Your duty to disclose is continuing. If a new situation arises, or a disclosed situation changes in any material way, submit an updated form within a reasonable time of becoming aware of the change. The Company may also ask you to reconfirm or refresh this disclosure periodically, for example during an annual review cycle.
I, Full name, holding the position of Role title, confirm that the information provided on this form is complete and accurate to the best of my knowledge, that I have not omitted any situation I know could create a conflict of interest or the appearance of one, and that I will promptly disclose future changes as described above.
Signature: ✍ Signer signature Date: Signature date
Highlighted fields are filled in when you customize and send this document on Diiirect.
Not legal advice
This template is provided for general informational purposes only and is not legal advice. Laws differ by jurisdiction and change over time — have a qualified professional review any document before you rely on it.
A structured ramp plan managers adapt per role: learning goals for the first month, ownership goals for the second, delivery goals for the third, with owners and checkpoints.
An anti-harassment and anti-discrimination policy defining prohibited conduct, the complaint procedure, investigations, and retaliation protection, ending in a signed acknowledgment. Use it to document that every hire has read the policy.
A candidate-facing consent form for background screening that sets out what the check may cover, how data is handled, and the candidate's rights. Use it before ordering any screening.
Personal-device policy with a security baseline, device-management consent, data separation rules, and off-boarding data removal, closed by a signed acknowledgment. Use it before granting work access on a personal phone or laptop.
A complete code of conduct covering respect, integrity, conflicts of interest, company assets, and reporting channels, with a signature confirming agreement to uphold it. Use it during onboarding for every new team member.
Authorizes the company to deposit pay into a nominated bank account, with a clear procedure for changing accounts and stopping the authorization.