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Relationship Disclosure Form
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Relationship Disclosure Form
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Last modified
2/3/2022 9:35:49 AM
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11/28/2017 12:11:07 PM
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IDAHO DEPARTMENT OF CORRECTION <br /> Relationship Disclosure Form <br /> Type of Disclosure <br /> ❑ Conflict of Interest ❑ Family Relation Hired ❑ Nepotism <br /> ❑ Relative or Friend in System ❑ Romantic Relationship ❑ Unprofessional Relationship <br /> ❑ Other: <br /> Disclosing Party Information <br /> Name: IDOC Facility: --Select-- <br /> Job Title: Supervisor's Name: <br /> Offender or Employee Information <br /> Name: IDOC Facility: --Select-- <br /> Offender# (if applicable): Job Title (if applicable): <br /> Supervisor's Name (if applicable): <br /> Describe the Relationship <br /> In describing the relationship between you and the affected party, please answer the following questions: <br /> (1) How long has the relationship existed? (2)What date (or approximate date)did the relationship start? <br /> (3)What is the current status of the relationship? (4) Is the affected party in your direct chain-of- <br /> command? <br /> What is your analysis of the impact this relationship may have on the IDOC or your unit? If you think the <br /> impact may be negative, what solutions do you recommend? <br /> (Disclosing Party's Signature) Date <br /> Supervisor/Manager Use Only <br /> Plan of Action: Supervisor must staff the situation with a facility head, district manager, or designee and <br /> agree on a plan of action. Keep all information regarding this situation confidential. <br /> Describe the plan of action. <br /> Sign and route this form to the next approval authority. <br /> Supervisor's Signature Facility Head, District Manager, or Bureau/Division Chief's, <br /> Designee's Signature (if applicable) Director's, or Designee's <br /> Signature(as applicable) <br /> (Appendix last updated 5/13/11 ) Original: Personnel File-HRS <br />
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