ࡱ > h j g bjbj)) * K K R Q / t t D D 8 $ $ ] T ( d " h > $ |S \ \ \ \ \ \ , p_ "b b \ F F " \ D D \ D D 8 |S |S j N | S p[u쭃 ` R O 2 hS \ 0 ] P b b d S S d \ \ ] b t : о of New Jersey SUPERVISORY CONFLICTS OF INTEREST CERTIFICATION Name: Telephone/Ext: Unit: Title: Full-Time: FORMCHECKBOX Part-Time: FORMCHECKBOX Division:(Check One) FORMCHECKBOX Academic Affairs FORMCHECKBOX Student Affairs FORMCHECKBOX Administration & Finance FORMCHECKBOX Institutional Advancement This certification is made in accordance with the New Jersey State Ethics Commission regulations, N.J.A.C. 19:61-5.7, and the Uniform Ethics Code, which prohibits a State officer or employee, or Special State officer, from supervising or exercising authority with regard to personnel actions over a relative*, cohabitant or someone a State employee or officer is dating. By my signature below, I certify that I have undertaken a review of the employees directly under my supervision/chain of command and have made the following determination: Check one: FORMCHECKBOX I do not supervise or have any personnel authority over a relative, someone I live with or someone I am dating. FORMCHECKBOX I do supervise or have/exercise personnel authority over a relative, someone I live with or someone I am dating. (If box is checked, indicate in space provided, name, title and relationship of subordinate who is your relative, person you live with or are dating). Print Name Date Signature Title *Relative means an individuals spouse or the individuals or spouses parent, child, brother, sister, aunt, uncle, niece, nephew, grandparent, grandchild, son-in-law, daughter-in-law, stepparent, stepchild, stepbrother, stepsister, half-brother, half-sister. Note: This completed and signed form should be sent to Employee Relations within two weeks of receipt. PAGE PAGE 1 Nepotism Policy Procedure BOARD OF TRUSTEES PROCEDURE 2/22/2010 N O U ] m q w x { ɺq[I "hS hS 5>*CJ OJ QJ ^J +jt hS hS CJ OJ QJ U^J +j hS hS CJ OJ QJ U^J %j hS hS CJ OJ QJ U^J hS hS 5CJ OJ QJ ^J hS hS >*CJ OJ QJ ^J hS hS CJ OJ QJ ^J h hS 5>*OJ QJ ^J &hS hS 5>*CJ OJ QJ ^J aJ #hS hS 5CJ OJ QJ ^J aJ N O q r u v ~ ~ $00]0^0a$gdS $ x 00]0^0a$gdS $ x 00]0^0a$gdS $ L 00]0^0a$gdS $00]0^0a$gdS $0]0a$gdS $0]0a$gd8 ! / 0 1 J K Y Z [ $ % 3 4 5 DZǛDžu_I +j, hS hS CJ OJ QJ U^J +j hS hS CJ OJ QJ U^J hS hS 5CJ OJ QJ ^J +jD hS hS CJ OJ QJ U^J +j hS hS CJ OJ QJ U^J +j\ hS hS CJ OJ QJ U^J hS hS CJ OJ QJ ^J %j hS hS CJ OJ QJ U^J +j hS hS CJ OJ QJ U^J # $ ? @ O Q R T 8f! ] $00dh ]0^0a$gdS $0]0^`a$gdS $00]0^0a$gdS 5 @ Q R S U V X Y [ \ ^ _ ` b c i j k l m n t u v w x ļvkv h]! 5CJ OJ QJ h%uP 5CJ OJ QJ h8 0J mH nH uh! hS hS 0J j hS 0J Uh%uP j h%uP Uj h%uP Uh# j h# UhS h%uP CJ OJ QJ hS hS 5CJ OJ QJ ^J hS hS >*CJ OJ QJ ^J hS hS CJ OJ QJ ^J &T U W X Z [ ] ^ a b k l m x x gd%uP x !$h0d, ]h^0gdS h]hgdS &`#$gd! 0^0 ˾˃ hS h%uP CJ OJ QJ h*| h*| CJ aJ h*| CJ OJ QJ aJ h%uP CJ$ OJ QJ h# h%uP CJ$ OJ QJ hRA} h%uP CJ OJ QJ h# h%uP ha h%uP CJ OJ QJ ^J aJ h*| CJ OJ QJ ^J aJ hn CJ OJ QJ ^J aJ 8f! ] ( / =!"# $% t D e C h e c k 5 t D e C h e c k 5 t D e C h e c k 5 t D e C h e c k 2 t D e C h e c k 3 t D e C h e c k 4 t D e C h e c k 5 t D e C h e c k 5 W# D d d X c 4 A R a m l o g o " " G(߬= " @=" &H0,̒5c E ' _ M" x{ ]UyĈ $0@IPTŐT$v CmEv#$Kqt֬g$jQcDĉfY}ι֫S=D}ܻ>{2 Mø?|<h<05=x2&a|6>5=FB.XWή{A#`V ߉ w]Wn#yt֍mA'c]Mۛݥ\fA'vv8loqYX,$NN :aqtHƕ'GF(O%bHҠ!iB