Outside Employment or Services

Outside Employment or Services - Ethics Disclosure

State of Alaska, Department of Law
First Name
Last Name
Email
example@example.com
Position Title
Department
Division / Agency / Public Corporation
City
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Direct Supervisor's Full Name

First NameLast Name
Direct Supervisor's Email Address
first.last@alaska.gov (copy-paste from Directory to ensure accuracy)
Designated Ethics Supervisor
Not sure who your designated ethics supervisor is? See the Department of Law's Executive Branch Ethics page.
Your Agency's Designated Ethics Supervisor

First NameLast Name
Designated Ethics Supervisor's Email Address
first.last@alaska.gov (copy-paste from Directory to ensure accuracy)
Acknowledgment of Outside Employment or Services
I am providing notice of my outside employment or provision of services for compensation, as required by AS 39.52.170(b).

Note: You are not required to disclose volunteer work unless it is a potential conflict with your state duties or you receive any type of compensation, including travel or meals. If you are a part-time State employee clearly identify and explain your part-time status; and other employment you have.
This employment or service consists of the following (describe in detail):
Employer name, scope of duties, type of compensation, etc.
The hours and days I work or provide services are:
Examples: 5 hours a week on Saturday and Sunday / 6pm-10pm Monday through Friday / 3 hours, 1 day a month
Note: “Incompatible or in conflict” means:

1) Takes time away from an employee's official duties;

2) Limits the scope of the employee's official duties; or

3) Is otherwise incompatible or in conflict with the proper discharge of the employee's official duties. See 9 AAC 52.090.
State whether any of these hours or days will conflict with your regular work schedule:
Describe the conflict with your regular work schedule:
Independent Contractor or Consultant
Are you working as an independent contractor or a consultant?
List of Clients

Cancelof
Note: If your outside job duties are the same or similar to your State service, or if you will be dealing with people or
entities with whom you deal or may deal as part of your official duties, you must explain why no potential conflict exists
between your outside employment and your official duties. If a potential conflict exists, you must refrain from taking any
action until it is approved by your designated ethics supervisor. See AS 39.52.210.
Approvals
Signature*
Please verify that you are human
Should be Empty:

Outside Employment or Services - Ethics Disclosure

Designated Ethics Supervisor

Acknowledgment of Outside Employment or Services

Independent Contractor or Consultant

Approvals