The Conflict Of Interest Form Template – Canada is offered in multiple formats, including PDF, Word, and Google Docs. All versions are conveniently editable and printable, ensuring they cater to your specific requirements effortlessly.
Conflict Of Interest Form Template – Canada Editable – PrintableSample
1. Parties Involved 2. Purpose of the Conflict of Interest Form 3. Nature of Conflict 4. Relationships Disclosed 5. Guidelines for Management of Conflict 6. Reporting and Review Process 7. Consequences of Non-Disclosure 8. Acknowledgment of Completion 9. Signatures and Date
PDF
WORD
Examples
[Applicant’s Name]
[Applicant’s Position]
[Department]
[Contact Information]
[Date]
I hereby declare any potential conflict of interest that may arise in connection with my responsibilities within [Organization’s Name].
Please describe any personal, financial, or other interests that could potentially conflict with the duties expected of you:
[Detailed Description]
Describe how you plan to mitigate or avoid the conflict of interest:
[Mitigation Strategy]
If there are other relationships or situations that may influence your role, please provide details:
[Additional Information]
I acknowledge that failure to disclose a conflict of interest may lead to disciplinary action, including termination of employment.
[Applicant’s Signature]
[Date]
[Employee’s Name]
[Employee’s Position]
[Department]
[Contact Information]
[Date]
I, [Employee’s Name], declare the following potential conflicts of interest that may impact my decision-making within [Organization’s Name]:
Please list all personal, external business, or other interests that may create a conflict:
[Detailed Description]
Explain how the conflicts will be managed or resolved:
[Resolution Plan]
If there are any other aspects relevant to your situation, please outline them here:
[Additional Notes]
I affirm that I understand the responsibility to disclose conflicts of interest and the implications of failure to do so.
[Employee’s Signature]
[Date]
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