Download DISCLOSURE PURSUANT TO UTAH PUBLIC OFFICERS’ AND EMPLOYEES’ ETHICS ACT

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Transcript
DISCLOSURE PURSUANT TO
UTAH PUBLIC OFFICERS’ AND EMPLOYEES’ ETHICS ACT
UTAH CODE TITLE 67, CHAPTER 16
This disclosure is provided pursuant to the requirements of the Utah Public Officer’s and Employees’
Ethics Act, which prohibits a public employee from participating in their official capacity or receiving
compensation in respect to any transaction between the School District and any business entity in which
the public employee is an officer, director, employee or owner, unless disclosure has been made.
GRANITE SCHOOL DISTRICT EMPLOYMENT INFORMATION:
________________________________________
_______________
NAME
DOB
________________________________________
_______________
WORK LOCATION
JOB TITLE
________________________________________
_______________
IMMEDIATE SUPERVISOR
WORK PHONE
_________________
EMPLOYEE ID #
_________________
WORK PHONE
OTHER PUBLIC EMPLOYER, BUSINESS ENTITY, OR PERSON FROM WHICH YOU MAY RECEIVE
COMPENSATION:
____________________________________________________________
_________________
NAME OF OTHER ENTITY/PERSON
TIN or SSN
_____________________________________ __________________ ____ _______________
ADDRESS
CITY
STATE ZIP
__________________
BUSINESS PHONE
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
POSITION HELD BY DISTRICT EMPLOYEE IN REGARDS TO OTHER ENTITY
(Explain the precise nature and value of interest owned by the employee)
____________________________________
SIGNATURE OF EMPLOYEE
____________________________________
SIGNATURE OF SUPERVISOR
A copy of this disclosure must be provided to the Board of Education of Granite School District, the
Superintendent, the Director of Purchasing, and the employee’s immediate supervisor.