McNeese State University
Outside Employment/Income, Conflict of Interest, and Conflict of Commitment Disclosure Form
All McNeese employees must complete on an annual basis an Outside Employment/Income, Conflict of Interest, and Conflict of Commitment Disclosure Form. Employees should review the policy on Conflict of Interest and Conflict of Commitment. All employees must complete the disclosure form each year and must update this form if there are any significant changes in outside interests or commitments, or your McNeese position/responsibilities during the year. All employees have a responsibility to report on an annual and ad hoc basis when professional activities, financial interests and relationships could have, or could be perceived to have, an impact on his/her University responsibilities. This Form requires the individual to report any and all leadership roles, secondary commitments and financial interests outside of McNeese. In addition, this form requires the individual to report any and all leadership roles, secondary commitments and financial interests that the individual‟s immediate family may have that could reasonably be expected to affect, or appear to affect, the professional judgment of a McNeese employee. Faculty and Staff must submit completed disclosure forms to their immediate supervisor. Newly hired or affiliated employees must submit a Disclosure Form within the first three months of employment or affiliation, and must thereafter comply with the annual filing deadline each fall. Failure to submit a completed Disclosure Form may have significant employment consequences. Immediate supervisors must review and sign every disclosure form received from each employee before submitting to the Dean/Administrative Supervisor responsible for their unit. Deans/Administrative Supervisors will review disclosures and complete Part 4, the Disclosure Review and Management Plan, according to instructions before submitting to the Vice President/President responsible for their unit. Vice Presidents/President will review disclosures and management plans, and submit forms with recommended action to the COI Committee. COI Committee will accept or recommend revisions for acceptance of management plans. All disclosure forms will be maintained in the office of the President.All italicized words are defined in the Conflict of Interest and Conflict of Commitment Policy.